比较3.0T MRI与64层MSCT在术前对胃癌淋巴结转移的诊断价值

发布时间：2018-01-28 12:11

本文关键词： 胃癌 N分期淋巴结表观扩散系数磁共振扩散加权成像多层螺旋计算机X线断层扫描　出处：《宁夏医科大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的应用3.0T MRI及64层MSCT术前判定淋巴结性质,并进行N分期,比较二者对胃癌淋巴结转移的诊断价值。方法术前确诊并手术胃癌患者26例,术前行MSCT、MRI检查,进行N分期,与术后病理对照;通过临床术后病理与影像一一对应确定目标淋巴结,总结转移与非转移淋巴结的影像特点。结果 MRI、MSCT术前N分期与病理N分期一致性较好(kappa-test,p0.05),MRI与MSCT N分期的正确率分别为69.23%(18/26)、80.77%(21/26),其中MRI与MSCT判断N1分期的正确率分别为50.00%(1/2)、50.0%(1/2),N2分期的正确率分别为83.33%(5/6)、66.67%(4/6),N3a分期的正确率分别为69.23%(9/13)、80.00%(12/13),N3b分期的正确率分别为60.00%(3/5)、80.00%(4/5),MRI与MSCT对胃癌术前N分期与术后病理N分期一致性较好,且二者之间对N分期的准确率无统计学差异(Mc-Nemar test,p0.05);最终确定;53枚转移淋巴结、67枚非转移淋巴结,MR-DWI上转移、非转移淋巴结的短、长径分别是(1.053±0.156)cm、(2.348±0.611)cm和(1.020±0.144)cm、(2.138±0.817)cm,二者间差异无统计学意义;而转移淋巴结rADC值(0.719±0.075)低于非转移淋巴结rADC值(0.977±0.079),二者间差异有统计学意义(p=0.000)。MSCT上转移、非转移淋巴结短、长径分别是(1.066±0.171)cm、(2.191±0.676)cm和(1.020±0.144)cm、(2.138±0.818)cm,二者间差异无统计学意义;转移淋巴结强化程度(48.8±5.8)HU大于非转移淋巴结(24.2±8.3)HU,差异有统计学意义(p=0.000)。结论 1、MRI、MSCT胃癌术前N分期与术后病理N分期对比均一致性较好。2、MSCT对胃癌术前N3a、N3b分期准确性较高,其整体准确性高于MRI。3、MRI与MSCT对胃癌转移与非转移淋巴结的性质判定有一定的价值,并且各自对其总结特点。
[Abstract]:Objective to apply 3.0T MRI and 64-layer MSCT to determine the lymph node character and to carry on the N stage. Methods Twenty six patients with gastric cancer were diagnosed and operated before operation. MSCT MRI was performed before operation and N staging was performed and compared with postoperative pathology. Objective lymph nodes were determined by clinical pathology and imaging one-to-one correspondence. Imaging features of metastatic and non-metastatic lymph nodes were summarized. Results MRI. The preoperative N staging of MSCT was in good agreement with pathological N staging (P 0.05). The accuracy of MRI and MSCT N staging were 69.23 / 26 / 80.77 and 21 / 26 respectively. The accuracy of N1 staging by MRI and MSCT was 50.001 / 2 / 50.0 and 83.33 / 5 / 6, respectively. The accuracy of the 4 / 6 / 6 / 6 / N3a staging was 69.23 and the accuracy of the 9- / 13- / 80.00- / 80.00. The accuracy rates of N3b staging were 60.00and 80.004 / 5 respectively. MRI and MSCT were in good agreement with preoperative N staging and postoperative pathological N staging of gastric cancer. There was no statistical difference in the accuracy of N staging between the two groups. Final determination; There were 67 metastatic lymph nodes in 53 metastatic lymph nodes on MR-DWI. The length and diameter of non-metastatic lymph nodes were 1.053 卤0.156 cm. It was 2.348 卤0.611cm and 1.020 卤0.144cm, 2.138 卤0.817cm. there was no significant difference between them. The rADC value of metastatic lymph nodes was 0.719 卤0.075), which was lower than that of non-metastatic lymph nodes (0.977 卤0.079). The difference between the two groups was statistically significant. The non-metastatic lymph nodes were short and the long diameter was 1.066 卤0.171 cm. 2.191 卤0.676cm and 1.020 卤0.144cm / cm respectively, 2.138 卤0.818cm. there was no significant difference between the two groups. The degree of enhancement of metastatic lymph nodes was 48.8 卤5.8 Hu than that of non-metastatic lymph nodes (24.2 卤8.3). The difference was statistically significant (P < 0.01). The accuracy of preoperative N staging and postoperative pathological N staging of MSCT gastric cancer was higher than that of MRI.3. MRI and MSCT are valuable in determining the nature of metastatic and non-metastatic lymph nodes of gastric cancer.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.2;R730.44

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