MRI弥散加权成像评价食管癌纵隔淋巴结转移的临床研究

发布时间：2018-05-05 00:30

本文选题：磁共振成像 + 弥散加权成像　；参考：《济南大学》2014年硕士论文

【摘要】：目的1.评价DWI对胸段食管癌纵隔淋巴结转移的检出能力。 2.探讨ADC值对良恶性淋巴结鉴别诊断的意义。材料与方法 1.患者资料：收集分析2013年6月-2014年1月在山东省肿瘤防治研究院就诊并拟行手术治疗的胸段食管癌初诊患者45例，术前均经胃镜或食管镜以刷检细胞学和（或）活检病理证实为鳞癌或可疑鳞癌。所有患者术前均未经任何抗肿瘤治疗且具备完整、精确的临床及病理资料。所有病例均在术前一周内行MRI常规及弥散加权成像扫描。 2.检查方法：扫描设备：PHILIPS Achieva3.0T MR扫描仪。扫描参数：1）横断面T1WI序列：TR/TE10/2ms，层厚/间距4/1mm，FOV375mm，矩阵352X160；2）横断面T2WI序列：TR/TE1.5s/80ms，层厚/间距4/1mm，FOV375mm，矩阵352X160；3）横断面SPAIR序列：TR/TE1.4s/70ms，层厚/间距4/1mm，FOV375mm，矩阵352X160；4）冠状位T2WI序列：TR/TE1.8s/80ms，层厚/间距4/1mm，FOV375mm，矩阵352X160；5）DWI序列：TR/TE2.6s/52ms，层厚/间距4/1mm，FOV375mm，矩阵352X160，扩散加权敏感系数b值分别取0，200s/mm2，400s/mm2，600s/mm2，800s/mm2。扫描范围从颈椎第4椎体上缘到腰椎第2椎体下缘。扫描时被扫描者双脚戴上鞋套，头部配戴耳机，取仰卧位、双臂放于身体两侧，安放、固定体部线圈，以头足位进入主磁场，扫描同时应用呼吸门控设备。 3.观察指标:应用飞利浦数字影像工作站，观察淋巴结的形态、大小、信号强度及ADC值。测量并记录淋巴结的位置、形态、大小、信号强度及ADC值。由两位从事MRI诊断工作的主任医师独立阅片，对存在不同意见的结果进行共同讨论取得一致意见后作为最终结果。 4.淋巴结分组及转移淋巴结的DWI诊断标准：食管癌术中进行广泛淋巴结清扫，，以日本食管疾病学会制定的标准对淋巴结进行分组及编号，对术中清扫淋巴结进行分组送检，记录每位患者的淋巴结转移数目。上纵隔淋巴结包括105、106F、106R、106L、106TL、106TR、113和114组淋巴结，中纵隔包括107、108、109及112组淋巴结，下纵隔包括110和111组淋巴结。所扫到的淋巴结在DWI图像上呈明显高信号，且其测量的ADC值与病变部位所测得的ADC值相差不大，就被认定为疑似转移淋巴结。 5.统计学分析采用SPSS17.0软件进行数据处理。计量资料数据以（x±s表示），ADC值与淋巴结转移之间的关系采用t检验，DWI诊断的食管癌纵隔淋巴结转移与手术后经病理证实的淋巴结转移进行比较并采用配对t检验方式进行检验，P0.05为差异有统计学意义。采用ROC曲线确定ADC值鉴别诊断食管癌淋巴结转移的阈值，计算相应的敏感度、特异度、阴性预测值、阳性预测值及准确率。结果 1.临床资料及病理结果：本组病例男性28例，女性17例；年龄50～75岁，平均年龄62.5岁，按AJCC-UICC国际食管癌TNM分期系统（2009）分段标准，胸中段食管癌18例，胸下段食管癌27例。本组45例患者中，有13例发生淋巴结转移转移率为28.9%；共清扫淋巴结585枚，平均每例患者清扫13枚，发生转移者147枚，淋巴结转移度为25.1%。 2.DWI对胸段食管癌纵隔转移淋巴结的诊断效能：按照既定诊断标准，术前DWI诊断为转移的淋巴结176枚；术后病理证实为转移的淋巴结131枚。DWI对胸段食管癌淋巴结转移与手术病理诊断淋巴结转移差异无统计学意义（t=0.46，P＞0.05）。DWI诊断淋巴结转移的敏感性、特异性、准确性、阳性和阴性预测值分别为89.1%、93.4%、92.3%、74.4%和96%。DWI对食管癌纵隔淋巴结转移的诊断价值优于常规序列；弥散成像灰阶反转图像显示淋巴结转移更加直观。 3.胸段食管癌纵隔淋巴结转移的DWI表现：接受检查的患者DWI上，脂肪、肌肉、血管等结构呈低信号强度，转移性淋巴结及原发灶为明显高信号强度。甲状腺、椎体及附件、肋骨为中等或略高信号强度。转移性淋巴结的ADC值（[1.71±0.12）×10-3mm2／s]，低于非转移性淋巴结[（2.61±0.15）×10-3mm2／s]，差异有统计学差异（t=7.26，P0．05）。结论 1.DWI诊断食管癌纵隔淋巴结转移与手术病理诊断淋巴结转移差异无统计学意义（t=0.46，P＞0.05）。DWI诊断淋巴结转移的敏感性、特异性、准确性、阳性和阴性预测值分别为89.1%、93.4%、92.3%、74.4%和96%。DWI对食管癌纵隔淋巴结转移的诊断价值优于常规序列；磁共振DWI对食管癌纵隔淋巴结转移的诊断具有重要价值。 2.食管癌转移性淋巴结的ADC值显著低于非转移性淋巴结。
[Abstract]:Objective 1. to evaluate the detection ability of DWI in mediastinal lymph node metastasis of thoracic esophageal carcinoma.
2. to explore the significance of ADC in differential diagnosis of benign and malignant lymph nodes.
Materials and methods
1. patients' data were collected and analyzed in 45 cases of early diagnosis of thoracic esophageal cancer in Shandong tumor prevention and Treatment Institute of Shandong in June 2013 and January. All patients were treated by gastroscope or esophagoscope by cytology and (or) biopsy pathology as squamous or suspected squamous cell carcinoma. All patients were not treated with any antitumor treatment before operation and Complete and accurate clinical and pathological data were available. All patients underwent routine MRI and diffusion weighted imaging within one week before operation.
2. check methods: scanning equipment: PHILIPS Achieva3.0T MR scanner. Scanning parameters: 1) cross section T1WI sequence: TR/TE10/2ms, layer thickness / spacing 4/1mm, FOV375mm, matrix 352X160; 2) cross section T2WI sequence: TR/TE1.5s/80ms, layer thickness / interval 4/1mm, FOV375mm, matrix, 3) cross section sequence: thickness / spacing M, FOV375mm, matrix 352X160; 4) coronal T2WI sequence: TR/TE1.8s/80ms, layer thickness / spacing 4/1mm, FOV375mm, matrix 352X160; 5) DWI sequence: TR/TE2.6s/52ms, layer thickness / interval 4/1mm, FOV375mm, matrix, diffusion weighted sensitivity coefficients respectively from the upper edge of the cervical vertebra to the waist to the waist The lower edge of the vertebral second vertebral body. When scanned, the scanned people wear the shoes with their feet and the headphones, take the supine position, put the arms on both sides of the body, put the body coils in the body, enter the main magnetic field with the head foot position, and apply the breathing door control equipment at the same time.
3. observation index: using PHILPS digital image workstation to observe the morphology, size, signal intensity and ADC value of lymph nodes, measure and record the location, shape, size, signal intensity and ADC value of the lymph nodes. The chief physician who is engaged in the diagnosis of MRI is independent to read the film, and makes a common discussion on the results of different opinions. See back as the final result.
The DWI diagnostic criteria for 4. lymph node groups and metastatic lymph nodes: extensive lymph node dissection during esophageal cancer surgery. The lymph nodes were grouped and numbered by the standards set by the Japanese Society for esophageal disease. The lymph nodes were divided into groups and the number of lymph node metastases in each patient was recorded. The upper mediastinal lymph nodes included 105106F, 106R, 106L, 106TL, 106TR, 113, and 114 groups of lymph nodes, middle mediastinum, including 107108109 and 112 groups of lymph nodes, the inferior mediastinum included 110 and 111 groups of lymph nodes. The lymph nodes that were swept were obviously high signal on the DWI image, and the measured ADC values were not quite different from the ADC values measured by the lesion, and they were identified as suspected metastatic lymph nodes.
5. statistical analysis was carried out by SPSS17.0 software. The data was measured by (x + s). The relationship between the ADC value and lymph node metastasis was examined by t test. The lymph node metastasis of the mediastinal lymph node diagnosed by DWI was compared with the lymph node metastasis confirmed by pathology and tested by paired t test. P0.05 was the difference. The ROC curve was used to determine the threshold value of ADC value in differential diagnosis of lymph node metastasis of esophageal cancer, and the corresponding sensitivity, specificity, negative predictive value, positive predictive value and accuracy were calculated.
Result
1. clinical data and pathological results: 28 cases in this group, 17 cases in women, 50~75 years old, with an average age of 62.5 years. According to the standard of AJCC-UICC international esophageal cancer TNM staging system (2009), 18 cases of middle thoracic esophagus carcinoma and 27 cases of lower thoracic esophagus carcinoma. 13 cases of lymph node metastasis rate were 28.9% in 45 cases of this group. 585 patients were fawning, 13 patients were removed in each case, 147 patients had metastasis, and the lymph node metastasis rate was 25.1%.
Diagnostic efficacy of 2.DWI for mediastinal metastatic lymph nodes of thoracic esophageal carcinoma: according to established diagnostic criteria, 176 metastatic lymph nodes were diagnosed by preoperative DWI, and 131.DWI for lymph node metastases confirmed by pathology were not statistically significant (t=0.46, P > 0.05).DWI diagnosis for lymph node metastasis of thoracic esophageal cancer. The sensitivity, specificity, accuracy, positive and negative predictive values of lymph node metastases were 89.1%, 93.4%, 92.3%, 74.4% and 96%.DWI were better than conventional sequences in the diagnosis of mediastinal lymph node metastasis of esophageal cancer, and the diffusion imaging gray scale reversal images showed that lymph node metastasis was more intuitive.
The DWI manifestations of the mediastinal lymph node metastasis of 3. thoracic esophageal carcinoma: the structure of fat, muscle, and blood vessels was low signal intensity on DWI, and the metastatic lymph nodes and primary foci were high signal intensity. The thyroid, vertebral and appendages were medium or slightly high intensity. The ADC value of the metastatic lymph nodes ([1.71 + 0.12) x / 10-3mm2 S] was lower than that of non metastatic lymph nodes [(2.61 + 0.15) x 10-3mm2 / s], the difference was statistically significant (t=7.26, P0.05).
conclusion
1.DWI diagnosis of esophageal carcinoma mediastinal lymph node metastasis and pathological diagnosis of lymph node metastasis was not statistically significant (t=0.46, P > 0.05).DWI diagnosis of lymph node metastasis sensitivity, specificity, accuracy, positive and negative predictive values of 89.1%, 93.4%, 92.3%, 74.4% and 96%.DWI for the diagnosis of esophageal carcinoma mediastinal lymph node metastasis is better than usual. Magnetic resonance DWI is of great value in the diagnosis of mediastinal lymph node metastasis of esophageal carcinoma.
2. the ADC value of metastatic lymph nodes of esophageal cancer was significantly lower than that of non metastatic lymph nodes.

【学位授予单位】：济南大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R735.1;R445.2

【参考文献】