3.0T MR食管癌成像与病理对照研究

发布时间：2018-03-12 09:20

  本文选题：食管癌　切入点：高分辨成像　出处：《郑州大学》2017年硕士论文　论文类型：学位论文

【摘要】：背景和目的:食管癌在世界恶性肿瘤中发病率排名第八位。然而,由于其术前分期晚且缺乏准确的术前分期手段,因此预后较差。CT常用于评价食管癌对周围组织结构侵犯及远处转移,但由于其软组织分辨率较低,不能准确判定管壁浸润深度。超声内镜可准确判定食管癌黏膜内及黏膜下侵犯,但由于其探测范围有限,对食管壁固有肌层及外膜浸润的判定仍有其局限性。文献报道,磁共振成像能用于食管癌管壁浸润深度的评估,有望替代CT和超声内镜作为食管癌精准分期的影像学检查方法。因此本研究旨在探讨3.0 T MR食管癌成像在食管癌分期诊断中的应用价值。第一部分离体食管癌标本3.0 T磁共振高分辨成像与病理对照研究目的:探讨3.0 T磁共振高分辨成像正常食管壁信号特征及对食管癌精准分期的诊断价值材料和方法:使用小动物线圈对经胃镜活检证实的95例离体食管癌标本行3.0 T磁共振高分辨成像。由两名影像诊断医师采用随机、独立、盲法对离体食管癌标本MR图像进行分析并分别做出影像学分期,当两名医师意见分歧时经协商达成一致。匹配相对应的磁共振断层图像和病理图像,对比食管癌磁共振影像分期与病理分期。用Kappa一致性检验比较磁共振影像分期与病理分期以及两名观察者之间的一致性;灵敏度、特异度、准确度用于评价3.0 T磁共振影像精准分期的诊断效能。结果:3.0 T MR高分辨成像可显示正常食管壁8层组织解剖学结构,磁共振图像显示的信号分层与食管壁的组织学分层一一对应。95例中86例磁共振影像分期与病理分期一致(90.5%,86/95),一致性较高(Kappa值=0.870)。MR高分辨率成像对T1a期食管癌诊断的敏感度、特异度和准确度分别为76.9%、97.6%和94.7%;对T1b期诊断的上述指标分别为80.6%、95.3%和90.5%;对T2期诊断的上述指标分别为100%、94.2%和95.8%;对T3期及以上分期诊断的上述指标分别为100%、100%和100%。结论:3.0 T MR高分辨成像能够显示正常食管壁组织学分层,对离体食管癌标本的分期诊断具有较好的灵敏度、特异度和准确度。第二部分离体食管癌标本高分辨T2-mapping成像与病理对照研究目的:采用T2-mapping成像对正常食管壁不同分层及食管癌的信号特征进行定量分析,评价食管癌管壁浸润深度,并与相应的组织病理学层面进行对照。材料和方法:前瞻性纳入52例新鲜离体食管癌标本行3.0 T MR成像,测量正常食管壁不同分层及肿块的T2值。由三名影像诊断医师随机、独立、盲法进行磁共振影像分期,当意见分歧时经协商达成一致。匹配相对应的磁共振断层影像与病理图像,对比食管癌磁共振影像分期与病理分期。Games-Howell检验用于比较正常食管壁不同分层间及其与肿块间T2值的差异。Spearman相关系数用于比较磁共振影像与病理分期相关性。三名观察者之间的一致性比较采用kappa一致性检验;灵敏度、特异度、准确度、阳性预测值、阴性预测值用于评价磁共振影像精准分期的诊断效能。结果:高分辨T2-mapping成像可显示正常食管壁8层组织解剖学结构。T2-mapping图像所显示解剖分层与正常食管壁的组织学分层一一对应。除内环肌外(P=0.790),正常食管壁不同解剖分层间、正常食管壁不同分层与肿块的T2值间差异具有统计学意义(P0.01)。52例中47例磁共振影像分期与病理分期一致,过高分期3例,过低分期2例,MRI分期和与病理分期一致(90.4%,47/52),一致性较高(r=0.968,P0.01)。MR高分辨率成像对T1a期食管癌诊断的敏感度、特异度和准确度分别为75%,95.5%和92.3%;对T1b期诊断的上述指标分别为80%,94.6%和90.4%;对T2期诊断的上述指标分别为100%,97.4%和98.1%,对T3/T4期诊断的上述指标分别为为100%,100%和100%。结论:3.0 T MR高分辨T2-mapping成像能够对正常食管壁不同组织学分层及肿瘤的信号特征进行定量分析,对食管癌管壁浸润深度的判定具有较高的灵敏度、特异度和准确度。第三部分3.0 T MR高分辨成像食管癌术前分期与病理对照研究目的:探讨3.0 T MR高分辨成像对食管癌术前分期诊断的价值。材料和方法:前瞻性连续性纳入经胃镜活检证实,并行3.0 T MR成像,且手术切除的食管癌患者135例。由三名影像诊断医师进行MRI分期,当意见分歧时经协商达成一致;一名病理诊断医师进行病理分期。同时测量肿瘤最大横径处肿块的厚度。kappa一致性检验用于评价MRI分期与病理分期及三名影像诊断医师分期间的一致性。以病理结果为金标准,计算食管癌MRI分期的灵敏度、特异度、准确度。Bland-Altman散点图用于比较三名影像诊断医师之间以及他们分别与病理诊断医师之间所测量肿块厚度的一致性。结果:109例食管癌患者MRI分期与病理分期一致(80.7%,109/135),一致性好(Kappa值=0.753)。MRI对T1a期食管癌诊断的灵敏度、特异度、准确度分别为57.1%、98.3%、94.1%(;对T1b期分别为73.9%、94.6%、91.1%;对T2期分别为76.9%、93.6%、90.4%;对T3期分别为78.4%、95.9%、91.1%;对T4a期分别为100%、95%、96.3%。Bland-Altman散点图表明三名影像诊断医师与病理诊断医师间所测厚度差平均分别为2.0 mm、2.6 mm及2.1 mm;三名影像诊断医师之间厚度差平均分别为0.6 mm、0.1 mm及0.4 mm;影像诊断医师与病理诊断医师间及各影像诊断医师间测量肿块厚度的一致性好。结论:3.0T MR高分辨率成像能够判定食管癌管壁浸润深度,对食管癌术前精准分期具有较大价值。
[Abstract]:Background and objective: esophageal cancer incidence rates in the world ranked eighth. However, due to the preoperative staging of late and the lack of accurate preoperative staging methods, so the poor prognosis of.CT commonly used in the evaluation of esophageal carcinoma with surrounding tissue invasion and distant metastasis, but because of its soft tissue resolution is low, can not accurately determine the wall infiltration depth. Endoscopic ultrasonography can accurately determine the esophageal mucosa and submucosal invasion, but due to the limited detection range of the esophageal wall, muscularis propria and adventitia infiltration determination still has its limitations. The literature reports, magnetic resonance imaging can be used to assess the invasion depth of esophageal cancer, is expected to replace CT and as the precise staging of esophageal cancer endoscopic ultrasound imaging method. Therefore this study aims to explore the application value of 3 T MR esophageal cancer imaging in staging diagnosis of esophageal carcinoma. The first part of the 3. standard of esophageal carcinoma in vitro 0 T high resolution magnetic resonance imaging and pathological control study objective: To explore the 3 T high resolution magnetic resonance imaging of normal esophageal wall and signal features of esophageal cancer staging accurate diagnostic value of materials and methods: the use of small animal coil on isolated esophageal cancer specimens for 3 T magnetic resonance imaging of high resolution imaging by endoscopic biopsy confirmed 95 cases by two radiologist using random, independent, blind method to analyze isolated esophageal cancer specimens and MR images were made when imaging staging, two physicians in disagreements by consensus. Matching the magnetic resonance tomographic images and pathological image contrast, magnetic resonance imaging and staging of esophageal cancer pathological staging. The consistency between the Kappa consistency test comparison of magnetic resonance imaging and pathological staging and two observers; the sensitivity, specificity and accuracy for the evaluation of 3 T magnetic resonance imaging precision stage The diagnostic efficacy. Results: 3 T high resolution MR imaging can display the anatomical structure of 8 layers of normal esophageal tissue, magnetic resonance imaging showed that the signal of stratification and esophageal wall tissue layers corresponding to.95 in 86 cases of magnetic resonance imaging and pathological staging (90.5%, 86/95), with high consistency (Kappa value =0.870).MR high resolution imaging for the diagnosis of stage T1a esophageal cancer sensitivity, specificity and accuracy were 76.9%, 97.6% and 94.7%; the index of T1b diagnosis were 80.6%, 95.3% and 90.5%; the index of T2 diagnosis were 100%, 94.2% and 95.8%; the index T3 and above staging were 100%, 100% and 100%. conclusion: 3 T high resolution MR imaging can display the school stratification of normal esophageal tissues on isolated esophageal cancer staging diagnosis has good sensitivity, specificity and accuracy. In the second part, from the body of food Tube carcinoma high resolution T2-mapping imaging and pathology of the objective: the signal characteristics of T2-mapping imaging of normal esophageal wall in different layers of esophageal cancer and quantitative analysis, evaluation of esophageal wall infiltration depth, and the corresponding pathological levels were compared. Materials and methods: 52 cases of isolated fresh esophageal cancer target the T MR imaging in 3 prospectively enrolled, measurement of normal esophageal wall in different layers of the mass and T2 value. By three radiologist random, independent, blind method for magnetic resonance imaging staging, when disagreements by consensus. The matching magnetic resonance tomographic imaging and pathology image corresponding to the magnetic contrast of esophageal cancer MR imaging and pathological staging in.Games-Howell test for comparing the difference between different layers of normal esophageal mass and T2 value of the.Spearman correlation coefficient for comparison of magnetic resonance imaging and pathology Staging correlation. The consistency between the three men were compared using kappa consistency test; sensitivity, specificity, accuracy, positive predictive value, negative predictive value for the evaluation of magnetic resonance imaging in precise staging. Results: the diagnostic efficiency of normal esophageal wall can display 8 layers of tissue anatomical structure of.T2-mapping image display and hierarchical anatomy the normal esophageal tissue layers and corresponding high resolution T2-mapping imaging. In addition to the inner muscle (P=0.790), normal esophageal wall in different anatomic layers, normal esophageal wall in different stratification and mass T2 values were statistically significant differences (P0.01) in.52 cases, 47 cases of magnetic resonance imaging and pathological staging, understaged in 3 cases, 2 cases of low stage, MRI staging and pathological staging and consistent (90.4%, 47/52), high consistency (r=0.968, P0.01).MR high resolution imaging for the diagnosis of stage T1a esophageal cancer sensitivity, specificity and The accuracies were 75%, 95.5% and 92.3%; the index of T1b diagnosis were 80%, 94.6% and 90.4%; the index of T2 diagnosis were 100%, 97.4% and 98.1%, the index of T3/T4 diagnosis were 100%, 100% and 100%. conclusion: 3 T MR high resolution signal characteristics T2-mapping imaging to normal esophageal tumors with different histological stratification and quantitative analysis of esophageal carcinoma has a high sensitivity to determine pipe wall invasion depth, specificity and accuracy. In the third part, 3 T high resolution MR imaging of esophageal cancer preoperative staging and pathological control study objective: To explore the 3 T high resolution MR imaging in the preoperative staging of esophageal cancer diagnosis. Materials and methods: a prospective continuously included by endoscopic biopsy confirmed that parallel imaging 3 T MR, 135 patients with esophageal cancer and surgical cases. By three radiologist in MRI stage, when In disagreements consensus through consultation; a pathological diagnosis of pathological staging. The thickness of physician.Kappa consistency test for simultaneous measurement of tumor maximum diameter of lesions for evaluation of MRI staging and pathological staging and three diagnostic imaging physician staging between consistent with pathological results as the gold standard to calculate the sensitivity, MRI staging of esophageal cancer the specificity and accuracy of.Bland-Altman plot for comparison between the three diagnostic imaging physician and their pathological diagnosis respectively and between physicians to measure the mass thickness consistency. Results: 109 cases of MRI patients with esophageal carcinoma and pathological staging (80.7%, 109/135), with good consistency (Kappa value =0.753) specific for.MRI the sensitivity of the diagnosis of stage T1a esophageal cancer, the accuracy is 57.1%, respectively, 98.3%, 94.1% (T1b; on stage were 73.9%, 94.6%, 91.1%; the T2 phase were 76.9%, 93.6%, 90.4%; the T3 phase were 78.4%, 95.9 %, 91.1%; for T4a stage were 100%, 95%, 96.3%.Bland-Altman scatterdiagram shows that three diagnostic imaging physician and pathology physicians between the thickness difference between the average were 2 mm, 2.6 mm and 2.1 mm; three radiologist between average thickness difference were 0.6 mm, 0.1 mm and 0.4 mm; diagnostic imaging physician and pathology physicians and each radiologist consistency between the measurement of mass thickness. Conclusion: 3.0T MR high resolution imaging can judge the esophageal wall infiltration depth, has great value in the staging of esophageal cancer preoperative accurate.

【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R735.1
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本文编号：1600948