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食管癌是最常见的消化道恶性肿瘤之一,排在全球癌症相关病死的第6位[1]。早期手术切除是食管癌的主要治疗方法,术前准确分期对于患者治疗方案的制定及预后至关重要。目前常用的分期方法为CT和超声内镜检查,超声内镜可精确显示食管壁的结构,但其为有创检查,且易受操作者技术的影响;CT的软组织分辨率低,故其诊断的准确率亦较低。MRI的软组织分辨率高,具有多序列成像的优点,可清晰显示食管壁的各层结构,且随着成像方式和设备技术的进步,心跳、呼吸及食管蠕动等磁敏感伪影对图像质量的影响均明显减少[2]。据报道,MRI在食管癌患者T分期中的效能优于其他影像学检查[3]。18F-FDG PET/MRI将PET代谢显像与高组织对比度的MRI相结合,二者联合检测在肿瘤分期中有明显优势[4-5]。PET/MRI自2011年应用于临床以来,多用于脑部及盆腔肿瘤的成像[6-8],目前国内外对PET/MRI应用于食管癌患者术前分期的研究报道极少。本研究回顾性分析30例行食管癌根治术患者的临床资料与影像学资料,对比分析18F-FDG PET/MRI和MRI在食管癌患者术前T、N分期中的应用价值。
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术前行18F-FDG PET/MRI检查的30例食管癌患者中,发现结肠占位1例,进一步行结肠镜和组织病理学检查确诊为结肠癌,同时行食管癌及结肠癌根治术;其余29例患者行食管癌根治术。术中发现食管癌原发灶位于食管上段1例、中段15例、下段11例、食管胃结合部3例。术后组织病理学检查结果显示,30例食管癌患者中,T1期3例、T2期4例、T3期14例、T4期9例;N0期16例、N1期6例、N2期7例、N3期1例;鳞癌26例、腺癌4例。
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18F-FDG PET/MRI与MRI在食管癌患者术前T分期和术后组织病理学分期的一致性均较强(Kappa值=0.757、0.698,均P<0.001);18F-FDG PET/MRI和MRI对食管癌患者术前T分期的诊断准确率分别为83.3%(25/30)、80.0%(24/30),二者的差异无统计学意义(χ2=0.110,P=0.740)。具体T分期情况见表1。T1~T4期食管癌患者的典型18F-FDG PET/MRI影像学表现见图1。
术后组织病理
学分期18F-FDG PET/MRI分期 MRI分期 T1~T2期 T3期 T4期 T1~T2期 T3期 T4期 T1~T2期(n=7) 7 0 0 7 0 0 T3期(n=14) 1 10 3 1 9 4 T4期(n=9) 0 1 8 0 1 8 注:FDG为氟脱氧葡萄糖;PET为正电子发射断层显像术;MRI为磁共振成像 表 1 18F-FDG PET/MRI和MRI对食管癌患者术前T分期与术后组织病理学分期的比较(例)
Table 1. Comparison of 18F-FDG PET/MRI and MRI in preoperative T staging and postoperative histopathological staging in patients with esophageal cancer (case)
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18F-FDG PET/MRI对食管癌患者术前N分期与术后组织病理学分期的一致性较强(Kappa值=0.640,P<0.001),MRI对食管癌患者术前N分期与术后组织病理学的一致性中等(Kappa值=0.477,P<0.001)。18F-FDG PET/MRI和MRI诊断对食管癌患者术前N分期的诊断准确率分别为76.7%(23/30)、66.7%(20/30),且差异有统计学意义(χ2=11.273,P=0.001)。具体N分期情况见表2。
术后组织病
理学分期18F-FDG PET/MRI分期 MRI分期 N0期 N1期 N2期 N3期 N0期 N1期 N2期 N3期 N0期(n=16) 12 2 1 1 13 2 0 1 N1期(n=6) 2 4 0 0 2 3 1 0 N2期(n=7) 0 1 6 0 0 2 4 1 N3期(n=1) 0 0 0 1 0 0 1 0 注:FDG为氟脱氧葡萄糖;PET为正电子发射断层显像术;MRI为磁共振成像 表 2 18F-FDG PET/MRI和MRI对食管癌患者术前N分期与术后组织病理学分期的比较(例)
Table 2. Comparison of 18F-FDG PET/MRI and MRI in preoperative N staging and postoperative histopathological staging in patients with esophageal cancer (case)
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共对30例食管癌患者的282个淋巴结进行组织病理学检查,其中37个淋巴结明确为转移性淋巴结(18F-FDG PET/MRI检出34个),245个淋巴结明确为良性淋巴结(18F-FDG PET/MRI检出192个)。由表3可知,转移性淋巴结的SUVmax和SUVmean均明显高于良性淋巴结,且差异均有统计学意义(均P<0.001);转移性淋巴结的ADCmin较良性淋巴结低,且差异有统计学意义(P<0.001),转移性淋巴结与良性淋巴结ADCmean的比较,差异无统计学意义(P>0.05)。
组别 SUVmax SUVmean ADCmin ADCmean 转移性淋巴结(n=34) 5.77±2.66 3.16±1.28 1.02±0.33 1.42±0.22 良性淋巴结(n=192) 2.79±1.29 1.78±1.01 1.20±0.24 1.48±0.29 t值 6.39 5.96 −3.81 −1.52 P值 <0.001 <0.001 <0.001 0.133 注:FDG为氟脱氧葡萄糖;PET为正电子发射断层显像术;MRI为磁共振成像;SUVmax为最大标准化摄取值;SUVmean为平均标准化摄取值;ADCmin为表观弥散系数最小值;ADCmean为表观弥散系数平均值 表 3 30例食管癌患者转移性淋巴结和良性淋巴结的18F-FDG PET/MRI半定量参数的比较(
)$\bar x \pm s $ Table 3. Comparison of 18F-FDG PET/MRI semiquantitative parameters in metastatic and benign lymph nodes of 30 patients with esophageal cancer (
)$\bar x \pm s $
18F-FDG PET/MRI与MRI在食管癌患者术前T、N分期中应用价值的对比分析
Comparative analysis of the application value of 18F-FDG PET/MRI and MRI in preoperative T, N staging of patients with esophageal cancer
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摘要:
目的 比较18F-氟脱氧葡萄糖(FDG)PET/MRI与MRI在食管癌患者术前T、N分期中的应用价值。 方法 回顾性分析2018年1月至2019年12月于空军军医大学第二附属医院行食管癌根治术的30例患者的临床资料与影像学资料,其中男性25例、女性5例,年龄42~77(62.9±8.0)岁。患者均在术前2周内行18F-FDG PET/MRI检查,以术后组织病理学检查结果为分期的“金标准”。采用Kappa检验评估18F-FDG PET/MRI和MRI对食管癌患者术前T、N分期与术后组织病理学分期的一致性;18F-FDG PET/MRI与MRI对食管癌患者术前T、N分期准确率的比较采用χ2检验;转移性淋巴结与良性淋巴结最大标准化摄取值(SUVmax)、平均标准化摄取值(SUVmean)、表观扩散系数最小值(ADCmin)、表观扩散系数平均值(ADCmean)的比较采用独立样本t检验。 结果 18F-FDG PET/MRI与MRI对食管癌患者术前T分期和术后组织病理学分期的一致性均较强(Kappa值=0.757、0.698,均P<0.001);18F-FDG PET/MRI和MRI对食管癌患者术前T分期诊断的准确率分别为83.3%(25/30)、80.0%(24/30),差异无统计学意义(χ2=0.110,P>0.05)。18F-FDG PET/MRI对食管癌患者术前N分期的诊断准确率高于MRI [76.7%(23/30)对66.7%(20/30)],且差异有统计学意义(χ2=11.273,P<0.01)。转移性淋巴结的SUVmax和SUVmean均明显高于良性淋巴结(5.77±2.66对2.79±1.29,3.16±1.28对1.78±1.01),且差异均有统计学意义(t=6.39、5.96,均P<0.001);转移性淋巴结的ADCmin较良性淋巴结低(1.02±0.33对1.20±0.24),且差异有统计学意义(t=−3.81,P<0.001);两者ADCmean的比较,差异无统计学意义(t=−1.52,P>0.05)。 结论 18F-FDG PET/MRI在食管癌患者术前T分期中的价值与MRI相当,且其对食管癌患者术前N分期的诊断效能优于MRI,故可成为食管癌患者术前分期优选的无创检查方法。 -
关键词:
- 食管肿瘤 /
- 正电子发射断层显像术 /
- 磁共振成像 /
- 氟脱氧葡萄糖F18 /
- 术前分期
Abstract:Objective To compare the application value of 18F-fluorodeoxyglucose (FDG) PET/MRI and MRI in the preoperative T and N staging of patients with esophageal cancer. Methods The clinical and imaging data of 30 patients who underwent radical resection for esophageal cancer in the Second Affiliated Hospital of the Air Force Military Medical University from January 2018 to December 2019 were retrospectively analyzed. The sample included 25 males and 5 females, aged 42–77(62.9±8.0) years old. All patients underwent 18F-FDG PET/MRI examination within 2 weeks before operation, and the postoperative histopathological examination results were used as the “gold standard” for staging. The Kappa test was employed to evaluate the consistency of 18F-FDGPET/MRI and MRI in the preoperative T and N staging of patients with esophageal cancer and in postoperative histopathological staging. The staging accuracy was compared using the χ2 test, and the values of the maximum standardized uptake (SUVmax), mean standardized uptake (SUVmean), apparent diffusion coefficient minimum vaalue (ADCmin), and apparent diffusion coefficient mean value (ADCmean) of metastatic lymph nodes and benign lymph nodes were compared using independent sample t test. Results 18F-FDG PET/MRI and MRI showed strong consistency in the preoperative T staging and postoperative histopathological staging of patients with esophageal cancer (Kappa value=0.757, 0.698; both P<0.001). The accuracy rates of 18F-FDG PET/MRI and MRI in the diagnosis of preoperative T staging in patients with esophageal cancer were 83.3% (25/30) and 80.0% (24/30) respectively, with no significant difference (χ2=0.110, P>0.05). The diagnostic accuracy of 18F-FDG PET/MRI for preoperative N staging in patients with esophageal cancer was higher than that of MRI (76.7% (23/30) vs. 66.7% (20/30)), and the difference was statistically significant (χ2=11.273, P<0.01). The SUVmax and SUVmean values of the metastatic lymph nodes were higher than those of the benign lymph nodes (5.77±2.66 vs. 2.79±1.29 and 3.16±1.28 vs. 1.78±1.01, respectively), and the difference was statistically significant (t=6.39, 5.96; both P<0.001). Furthermore, the ADCmin of metastatic lymph nodes was lower than that of benign lymph nodes (1.02±0.33 vs. 1.20±0.24), and the difference was statistically significant (t=−3.81, P<0.001). In comparison, there was no statistical significance in the comparison of ADCmean (t=−1.52, P>0.05). Conclusions The value of 18F-FDG PET/MRI in the preoperative T staging of patients with esophageal cancer is comparable to that of MRI, while its diagnostic performance for preoperative N staging of patients with esophageal cancer is better than MRI. Thus, it can be considered the preferred non-invasive preoperative staging method for patients with esophageal cancer. -
表 1 18F-FDG PET/MRI和MRI对食管癌患者术前T分期与术后组织病理学分期的比较(例)
Table 1. Comparison of 18F-FDG PET/MRI and MRI in preoperative T staging and postoperative histopathological staging in patients with esophageal cancer (case)
术后组织病理
学分期18F-FDG PET/MRI分期 MRI分期 T1~T2期 T3期 T4期 T1~T2期 T3期 T4期 T1~T2期(n=7) 7 0 0 7 0 0 T3期(n=14) 1 10 3 1 9 4 T4期(n=9) 0 1 8 0 1 8 注:FDG为氟脱氧葡萄糖;PET为正电子发射断层显像术;MRI为磁共振成像 表 2 18F-FDG PET/MRI和MRI对食管癌患者术前N分期与术后组织病理学分期的比较(例)
Table 2. Comparison of 18F-FDG PET/MRI and MRI in preoperative N staging and postoperative histopathological staging in patients with esophageal cancer (case)
术后组织病
理学分期18F-FDG PET/MRI分期 MRI分期 N0期 N1期 N2期 N3期 N0期 N1期 N2期 N3期 N0期(n=16) 12 2 1 1 13 2 0 1 N1期(n=6) 2 4 0 0 2 3 1 0 N2期(n=7) 0 1 6 0 0 2 4 1 N3期(n=1) 0 0 0 1 0 0 1 0 注:FDG为氟脱氧葡萄糖;PET为正电子发射断层显像术;MRI为磁共振成像 表 3 30例食管癌患者转移性淋巴结和良性淋巴结的18F-FDG PET/MRI半定量参数的比较(
)$\bar x \pm s $ Table 3. Comparison of 18F-FDG PET/MRI semiquantitative parameters in metastatic and benign lymph nodes of 30 patients with esophageal cancer (
)$\bar x \pm s $ 组别 SUVmax SUVmean ADCmin ADCmean 转移性淋巴结(n=34) 5.77±2.66 3.16±1.28 1.02±0.33 1.42±0.22 良性淋巴结(n=192) 2.79±1.29 1.78±1.01 1.20±0.24 1.48±0.29 t值 6.39 5.96 −3.81 −1.52 P值 <0.001 <0.001 <0.001 0.133 注:FDG为氟脱氧葡萄糖;PET为正电子发射断层显像术;MRI为磁共振成像;SUVmax为最大标准化摄取值;SUVmean为平均标准化摄取值;ADCmin为表观弥散系数最小值;ADCmean为表观弥散系数平均值 -
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