MSCT MPR技术诊断食管癌分期及淋巴结转移的价值

Value of MSCT MPR in the Diagnosis of Esophageal Cancer Staging and Lymph Node Metastasis

目的 探讨多层螺旋CT(MSCT)多平面重建(MPR)技术诊断食管癌分期及淋巴结转移的价值。方法 回顾性分析本院2019年1月至2021年10月收治的119例食管癌患者临床资料,所有患者均先后进行MSCT扫描,以手术病理结果为“金标准”,分析MSCT扫描MPR技术对食管癌分期及淋巴结转移的评估价值。结果 119例患者病理诊断包括T_(1)期15例,T_(2)期36例,T_(3)期55例,T_(4)期13例,MSCT扫描MPR技术诊断T分期准确率为75.63%(90/119);MSCT扫描MPR技术对食管癌T_(1)、T_(2)、T_(3)、T_(4)分期诊断与病理分期结果的Kappa一致性分别为0.647、 0.531、0.663、0.757;119例食管癌患者中,发生淋巴结转移者41例,未发生淋巴结转移者78例,影像学检查检出的693枚淋巴结中经病理学证实其中157枚为转移淋巴结,536枚为非转移淋巴结;转移淋巴结MSCT征象中淋巴结短径、长径、横纵比大于非转移淋巴结,边缘模糊、成簇分布、中央低密度比例高于非转移淋巴结(P<0.05);淋巴结横纵比比鉴别淋巴结转移与非转移ROC曲线下面积为0.839高于淋巴结短径、长径、边缘模糊、成簇分布、中央低密度评估曲线下面积0.756、0.652、0.575、0.562、0.582,淋巴结短径评估效能高于长径、边缘模糊、成簇分布、中央低密度(P<0.05);以淋巴结横纵比鉴别淋巴结转移与非转移,MSCT扫描MPR技术诊断食管癌N分期灵敏度80.49%、特异度65.38%、准确率70.59%,与病理结果Kappa值=0.413。结论 MSCT扫描MPR技术处理中用淋巴结短径作为转移淋巴结评估标准效能较高,而纵横比可进一步提高评估价值,MSCT扫描MPR技术可用于临床食管癌分期及淋巴结转移评估。

Objective To explore the value of multi-planar reconstruction(MPR)of multi-slice spiral CT(MSCT)in the diagnosis of esophageal cancer staging and lymph node metastasis.Methods A retrospective analysis was performed on the clinical data of 119 patients with esophageal cancer admitted to the hospital between January 2019 and October 2021.All underwent MSCT scans successively.Taking the surgical pathology results as the golden standard,evaluation value of MSCT MPR for esophageal cancer staging and lymph node metastasis was analyzed.Results The pathological diagnosis showed that in the 119 patients,there were 15 cases at stage T_(1),36 cases at stage T_(2),55 cases at stage T_(3) and 13 cases at stage T_(4).The accuracy rate of MSCT MPR in the diagnosis of T staging was 75.63%(90/119).The consistency Kappa values between MSCT MPR and pathological examination in the diagnosis of esophageal cancer at stages T_(1),T_(2),T_(3) and T_(4) were 0.647,0.531,0.663 and 0.757,respectively.In the 119 patients with esophageal cancer,there were 41 cases with lymph node metastasis and 78 cases without.In the 693 lymph nodes detected by imaging examination,pathological diagnosis showed that there were 157 metastatic lymph nodes and 536 non-metastatic lymph nodes.In MSCT signs,short diameter of lymph nodes,long diameter and aspect ratio in metastatic lymph nodes were greater than those in non-metastatic lymph nodes,and proportions of blurred edges,clustered distribution and central low density were higher than those in non-metastatic lymph nodes(P<0.05).The area under the curve(AUC)of lymph node aspect ratio in the differential diagnosis of lymph node metastasis and non-metastasis was 0.839,greater than that of lymph node short diameter,long diameter,blurred edge,clustered distribution and central low density(0.756,0.652,0.575,0.562,0.582).The evaluation efficiency of short diameter was higher than that of long diameter,blurred edge,clustered distribution and central low density(P<0.05).The sensitivity,specificity and accuracy of MSCT MPR in the diagnosis of N staging were 80.49%,65.38%and 70.59%,and the Kappa value between MSCT MPR and pathological examination was 0.413.Conclusion In MSCT MPR,short diameter of lymph nodes has high evaluation efficiency for metastatic lymph nodes,and the aspect ratio can further improve the evaluation value.MSCT MPR can be applied in clinical evaluation of esophageal cancer staging and lymph node metastasis.