大范围MRI扩散加权成像在食管\贲门癌淋巴结微转移中的应用(1)
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【摘要】 目的 探讨大范围磁共振扩散加权成像对食管、贲门癌术前分级及淋巴结转移的效果。方法 35例食管癌术前行大范围MRI扩散加权成像,判定异常淋巴结数量及位置,与手术所见及术后病理结果对比。结果 大范围MRI扩散加权成像发现淋巴结转移23例,病理结果转移18例,大范围MRI弥散成像无淋巴结转移12例,病理结果无转移9例;大范围MRI扩散加权成像、病理结果欠符合7例,总符合率80%,锁骨上和纵隔淋巴结符合率达82.8%,腹部淋巴结符合率55.6%。结论 大范围MRI扩散加权成像对食管、贲门癌术前判断淋巴结转移较敏感,是食管、贲门癌术前评估淋巴结转移情况好方法,对直径<0.5 cm的淋巴结良恶性判定尚有不足。
【关键词】 大范围MRI扩散加权成像;食管癌;贲门癌;淋巴结转移
Application of whole body diffusion weighted imaging in detecting lymph node metastasis of esophageal cancer and cardia cancer
QIN Yong-chun,FEI Li-cong,LI Cheng-li,et al. Department of Medical Imaging,Rizhao People’s Hospital,Shangdong,Rizhao 276800,China
【Abstract】 Objective To study the effect of whole body diffusion weighted imaging(DWI) in detecting lymph node metastasis of esophageal cancer and cardia cancer,and its value in grading before operation. Methods 35 patients withesophageal cancer or cardiac cancer were performed the detection of DWI before operation to determine the number and location of the abnormal lymph nodes,then the results were compared with the finds in operation and the histopathological observations. Results 23 cases were found with lymph node metastasis by DWI in which 18 cases were confirmed by histopathology,while in 12 cases in which no lymph node metastasis was fonud by DWI there were 9 cases to be confirmed by histopathology; in 7 cases DWI did not well correspond with histopathology. The total accordance rate was 80%,while for supraclavicular lymph nodes and mediastinal lymph nodes the accordance rate was 82.5%,and for celiac lymph nodes the accordance rate was 55.6%. Conclusion DWI offers a high-sensitive means to estimate the lymph node metastasis of esophageal cancer and cardia cancer,but lack of sensitivity in judgement on the nature of benignity or m alignancy for lymph nodes less than 0.5 cm in diameter.
【Key words】 Whole body diffusion weighted imaging(DWI); Esophageal cancer; Cardia cancer;Lymph node metastasis
对食管癌、贲门癌预后及个体化治疗而言,术前准确的临床分期、正确全面判断是否有淋巴结转移及转移程度非常重要[1],与手术指征的选择及手术清除是否彻底密切相关,笔者于2009年5月至2009年12月应用大范围MRI扩散加权成像对42例食管、贲门癌及周围淋巴结转移的检查准确性与术中、术后病理作一对照研究,探讨大范围MRI扩散加权成像在食管、贲门癌术前分期中效能。
1 资料与方法
1.1 临床资料 本组食管、贲门癌共42例,其中男34例,女8例,年龄46~80岁,平均年龄55岁。食管癌胸上段3例、胸中段30例、胸下段5例,贲门癌4例。 7例因发现远处转移而放弃手术 ......
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