MRI平扫结合体素内不相干运动(IVIM)成像在食管胃结合部腺癌术前T分期及病理分化程度的诊断价值
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摘要
目的探讨MRI平扫与体素内不相干运动模型(IVIM)对食管胃结合部腺癌术前T分期及病理分化程度评估的诊断价值。方法前瞻性研究经内镜证实为食管胃结合部癌,且最终行手术治疗获得病理结果的47例患者的临床和影像资料。所有患者术前一周内行MRI平扫及IVIM成像检查。将IVIM原始图像传至GEAW4.6后处理工作站。手动勾画感兴趣区(ROI),计算表观扩散系数(ADC)、真实扩散系数(D)、灌注相关扩散系数(D*)和灌注分数(f)。MRI平扫结合IVIM与手术病理T分期的结果一致性分析采用Kappa检验。结果47例患者MRI平扫结合IVIM术前T分期准确率分别为:T1期71.43%,T2期75.00%,T3期88.24%,T4期93.33%,总体准确率为85.11%。食管胃结合部腺癌不同病理分级间的ADC值与D值差异均有统计学意义(P<0.05),D*及f值差异无统计学意义(P>0.05)。结论 MRI平扫结合IVIM检查对食管胃结合部腺癌术前T分期及病理分化程度的评估具有重要临床指导意义。
Objective To prospectively determine the diagnostic performance of 3.0 T magnetic resonance imaging(MRI) routine sequence combined with intravoxel incoherent motion(IVIM) models in diagnosis of preoperative T staging and differentiating the pathological differentiated grade of esophagogastric junction adenocarcinoma.Methods Prospective study of 47 cases of patients with newly diagnosed adenocarcinoma of esophagogastric junction confirmed by electronic digestive tract endoscopy and surgical pathology results. All patients received conventional MRI plain scan and IVIM examination one weeks before operation. The images of IVIM were imported into the GE AW 4.6 workstation. Freehand ROI was used to cover the whole tumor volume, ADC,D, D* and f was calculated. Kappa consistency test was used to assess the consistency of T staging between the two methods. Results The accuracy of 3.0 T magnetic resonance imaging(MRI) routine sequence combined with IVIM-DWI MRI for T stages was85.77%, 71.43% for T1, 75% for T2, 88.24% for T3 and 93.33% for T4 and respectively.The ADC and D values had significant difference among the different histologic grade of AEGs(P<0.05), while the D* and f values had no difference(P>0.05). Conclusion 3.0 T magnetic resonance imaging(MRI) routine sequence combined with intravoxel incoherent motion(IVIM) models has great significance for preoperative assessment of T staging and differentiating the pathological of esophagogastric junction adenocarcinoma.
Objective To prospectively determine the diagnostic performance of 3.0 T magnetic resonance imaging(MRI) routine sequence combined with intravoxel incoherent motion(IVIM) models in diagnosis of preoperative T staging and differentiating the pathological differentiated grade of esophagogastric junction adenocarcinoma.Methods Prospective study of 47 cases of patients with newly diagnosed adenocarcinoma of esophagogastric junction confirmed by electronic digestive tract endoscopy and surgical pathology results. All patients received conventional MRI plain scan and IVIM examination one weeks before operation. The images of IVIM were imported into the GE AW 4.6 workstation. Freehand ROI was used to cover the whole tumor volume, ADC,D, D* and f was calculated. Kappa consistency test was used to assess the consistency of T staging between the two methods. Results The accuracy of 3.0 T magnetic resonance imaging(MRI) routine sequence combined with IVIM-DWI MRI for T stages was85.77%, 71.43% for T1, 75% for T2, 88.24% for T3 and 93.33% for T4 and respectively.The ADC and D values had significant difference among the different histologic grade of AEGs(P<0.05), while the D* and f values had no difference(P>0.05). Conclusion 3.0 T magnetic resonance imaging(MRI) routine sequence combined with intravoxel incoherent motion(IVIM) models has great significance for preoperative assessment of T staging and differentiating the pathological of esophagogastric junction adenocarcinoma.
引文
[1]Ajani JA, Bar the l JS,Ben t rem D J, et al. Esophageal and esophagogastric junction cancers[J].J Nat l Compr Cane Netw, 2011, 9(8):830-887.
[2]杨宏,武爱文,季加孚,等.食管胃结合部腺癌4 7 1例Siewer t分型临床研究[J].中国实用外科杂志,2012, 32(4):310-315.
[3]Sehdev A, Catenacci D V.Gastroesophageal cancer:focus on epidemiology,c lass ification,and staging[J].Discov Med,2013, 16(87):103-111.
[4]Dong H,Guo H, Xie L,et al.The metastasis-associated gene MTA3, a component of the Mi-2/NuRD transcriptional repression complex,predicts prognosis of gastroesophageal junction adenocarcinoma[J]. PLoS One,2013,8(5):e62986.
[5] Le Bihan D,Breton E,La llemand D,et a l. M R imaging of intravoxel incoherent motions:application to diffusion and perfusion in neurologic disorders[J].Radiology,1986,161:401-407.
[6] Le Bihan D,Breton E,Lallemand D,et al. Separation of diffusion and perfusion in intravoxel incoherent mot ion MR imaging[J].Radiology,1988, 168(2):497-505.
[7]Grana ta V,Fusco R,Catalano O,et al.Early Assessment of Colorectal Cancer Patients with Liver Metastases Treated with Antiangiogenic Drugs:TheRole of Intravoxel Incoherent Mot ion in Diffusion-Weighted Imaging[J].PLoS One,2015, 10:e0142876.
[8]van Zoonen M,van Oijen MG,van Leeuwen MS,et a l. Low impact of staging EUS for determining surgical resectability in esophageal cancer[J]. Surg Endosc,2012,26(10):2828-2834.
[9]Subasinghe D, Samarasekera DN.A study comparing endoscopic ultrasound(EUS)and computed tomography(CT)in staging oesophageal cancer and their role in clinical decision making[J]. J Gastrointest Cancer, 2010, 41(1):38-42
[10]Yamada I,Hikishima K,Miyasaka N, et a l. Esophageal carcinoma:ex vivo evaluation with diffusion-tensor MR imaging and tractography at 7 T[J].Radiology, 2014, 272(1):164-173.
[11]许晓雯,王培军,马亮,等. 3. 0T M R I扩散加权成像及灌注加权成像在肾脏良恶性肿瘤鉴别诊断中的价值[J].中华医学杂志,2015, 95(3):200-204.
[12]董海波,王高燕,李亚迪.多b值扩散加权成像在乳腺良恶性病变诊断中的应用价值分析[J].中华医学杂志,2017, 97(3):203-207.
[13]Rice TW,Ishwaran H,Ferguson MK, e t a l. Cancer of the esophagus and esophagogastric junction:an eighth edition staging primer[J].J Thorac Oncol, 2017, 12(1):36-42.
[14]Wang,C K,Kuo,Y T,Liu,G C,e t a l. Dynamic contrastenhanced subtract ion and delayed MRI of gastric tumors:radiologic-pathologic correlation[J]. J Comput Assist Tomogr,2000V24N6:872-877.
[15]耿晓丹,于丽娟,陈慕楠,等.MRI平扫结合DWI在胃癌术前T分期及淋巴结转移上的价值[J].中国癌症杂志,2016,26(7):629-634.
[16]叶泳松,陈棣华,蒋光愉,等.食管癌分期的MRI评估[J].临床放射学杂志,2006, 25(9):828-832.
[17]Sun H,Xu Y,Xu Q,Shi K,Wang W.Rectal cancer:Short-term reproducibility of intravoxel incoherent mot ion parameters in 3. 0T magnetic resonance imaging[J]. Medicine, 2017, 96:e6866.
[18]孙瑞红,尹化斌.基于体素内不相干运动的扩散加权成像在乳腺肿瘤中的应用进展[J].中华放射学杂志,2017, 51(8):633-635.
[19]杨英,许卫,戎冬冬,等.3.0T MRI普通平扫联合DWI对乳腺癌筛查的初步探讨[J].实用放射学杂志,2012, 28(12):1895-1901.
[2]杨宏,武爱文,季加孚,等.食管胃结合部腺癌4 7 1例Siewer t分型临床研究[J].中国实用外科杂志,2012, 32(4):310-315.
[3]Sehdev A, Catenacci D V.Gastroesophageal cancer:focus on epidemiology,c lass ification,and staging[J].Discov Med,2013, 16(87):103-111.
[4]Dong H,Guo H, Xie L,et al.The metastasis-associated gene MTA3, a component of the Mi-2/NuRD transcriptional repression complex,predicts prognosis of gastroesophageal junction adenocarcinoma[J]. PLoS One,2013,8(5):e62986.
[5] Le Bihan D,Breton E,La llemand D,et a l. M R imaging of intravoxel incoherent motions:application to diffusion and perfusion in neurologic disorders[J].Radiology,1986,161:401-407.
[6] Le Bihan D,Breton E,Lallemand D,et al. Separation of diffusion and perfusion in intravoxel incoherent mot ion MR imaging[J].Radiology,1988, 168(2):497-505.
[7]Grana ta V,Fusco R,Catalano O,et al.Early Assessment of Colorectal Cancer Patients with Liver Metastases Treated with Antiangiogenic Drugs:TheRole of Intravoxel Incoherent Mot ion in Diffusion-Weighted Imaging[J].PLoS One,2015, 10:e0142876.
[8]van Zoonen M,van Oijen MG,van Leeuwen MS,et a l. Low impact of staging EUS for determining surgical resectability in esophageal cancer[J]. Surg Endosc,2012,26(10):2828-2834.
[9]Subasinghe D, Samarasekera DN.A study comparing endoscopic ultrasound(EUS)and computed tomography(CT)in staging oesophageal cancer and their role in clinical decision making[J]. J Gastrointest Cancer, 2010, 41(1):38-42
[10]Yamada I,Hikishima K,Miyasaka N, et a l. Esophageal carcinoma:ex vivo evaluation with diffusion-tensor MR imaging and tractography at 7 T[J].Radiology, 2014, 272(1):164-173.
[11]许晓雯,王培军,马亮,等. 3. 0T M R I扩散加权成像及灌注加权成像在肾脏良恶性肿瘤鉴别诊断中的价值[J].中华医学杂志,2015, 95(3):200-204.
[12]董海波,王高燕,李亚迪.多b值扩散加权成像在乳腺良恶性病变诊断中的应用价值分析[J].中华医学杂志,2017, 97(3):203-207.
[13]Rice TW,Ishwaran H,Ferguson MK, e t a l. Cancer of the esophagus and esophagogastric junction:an eighth edition staging primer[J].J Thorac Oncol, 2017, 12(1):36-42.
[14]Wang,C K,Kuo,Y T,Liu,G C,e t a l. Dynamic contrastenhanced subtract ion and delayed MRI of gastric tumors:radiologic-pathologic correlation[J]. J Comput Assist Tomogr,2000V24N6:872-877.
[15]耿晓丹,于丽娟,陈慕楠,等.MRI平扫结合DWI在胃癌术前T分期及淋巴结转移上的价值[J].中国癌症杂志,2016,26(7):629-634.
[16]叶泳松,陈棣华,蒋光愉,等.食管癌分期的MRI评估[J].临床放射学杂志,2006, 25(9):828-832.
[17]Sun H,Xu Y,Xu Q,Shi K,Wang W.Rectal cancer:Short-term reproducibility of intravoxel incoherent mot ion parameters in 3. 0T magnetic resonance imaging[J]. Medicine, 2017, 96:e6866.
[18]孙瑞红,尹化斌.基于体素内不相干运动的扩散加权成像在乳腺肿瘤中的应用进展[J].中华放射学杂志,2017, 51(8):633-635.
[19]杨英,许卫,戎冬冬,等.3.0T MRI普通平扫联合DWI对乳腺癌筛查的初步探讨[J].实用放射学杂志,2012, 28(12):1895-1901.