高场强MRI与X线钡餐造影、胃镜诊断胃癌术后复发的对比分析

The diagnosis of recurrent gastric carcinoma: high-field-strength MRI compared with barium meal of alimentary canal and gastroscope

    摘要
  • 摘要:
    目的 通过高场强MRI与X线钡餐造影、胃镜检查的对比研究，探讨MRI在胃癌术后复发诊断中的应用价值。
    方法 收集临床拟诊胃癌术后复发患者53例，所有患者均接受MRI、X线钡餐造影、胃镜检查，以手术或穿刺活检病理结果为金标准，用卡方检验对上述检查方法进行统计分析。
    结果 53例胃癌术后患者经手术或穿刺活检病理证实：术后吻合口复发者30例，吻合口正常但发生周围及远处转移者10例，无复发者13例。MRI、X线钡餐造影和胃镜检查3种方法诊断胃癌术后吻合口复发的灵敏度、特异度、准确率、阳性预测值、阴性预测值分别为96.6%、86.9%、92.4%、90.6%、95.2%，70.0%、86.9%、77.3%、87.5%、68.9%，96.6%、91.3%、94.3%、93.5%、95.4%；诊断胃癌术后复发（包括胃外组织浸润、转移）的灵敏度、特异度、准确率、阳性预测值、阴性预测值分别为97.5%、76.9%、92.4%、92.8%、90.9%，52.5%、76.9%、58.4%、87.5%、34.4%，72.5%、84.6%、75.4%、93.5%、50.0%。诊断吻合口复发：MRI显著优于X线钡餐造影（ χ2=4.90，P < 0.05)，MRI与胃镜检查结果比较，差异无统计学意义(χ2=0.03，P > 0.05)；诊断胃癌术后复发（包括胃外组织浸润、转移）：MRI显著优于X线钡餐造影(χ2=12.46，P < 0.05)和胃镜检查( χ2=5.26，P < 0.05)。
    结论 在评价胃癌术后复发（包括胃外组织浸润、转移）中，MRI优于X线钡餐造影、胃镜检查；MRI对指导临床治疗方案，提高胃癌术后生存率具有重要的临床意义。

     

    Abstract:
    Objective To evaluate the clinical value of high-field-strength MRI in the diagnosis of recurrent gastric cancer compared with X-ray barium meal and gastroscope examinations.
    Methods All the 53 cases of postoperative recurrence of gastric cancer underwent MRI, X-ray barium meal and gastroscopy examinations.Using the results of surgery or biopsy as the gold standard, the differences in categorical data were analyzed with the Chi square test.
    Results Thirty postoperative recurrent gastric carcinoma in anastomotic stoma confirmed with pathological findings. There was ten cases with adjacent tissue infiltration and remote metastasis. Thirteen cases had no recurrent gastric carcinoma. The sensibility, specificity, accuracy, positive predictive value and negative predictive value for recurrent gastric carcinoma in anastomotic stoma for MRI, barium meal of alimentary canal and gastroscope were 96.6%, 86.9%, 92.4%, 90.6%, 95.2%; 70.0%, 86.9%, 77.3%, 87.5%, 68.9%; 96.6%, 91.3%, 94.3%, 93.5%, 95.4% respectively. The sensibility, specificity, accuracy, positive predictive value and negative predictive value for recurrent gastric cancer (including adjacent tissue infiltration and remote metastasis) were 97.5%, 76.9%, 92.4%, 92.8%, 90.9%; 52.5%, 76.9%, 58.4%, 87.5%, 34.4%; 72.5%, 84.6%, 75.4%, 93.5%, 50.0% respectively. There were significant differences between MRI and X-ray barium meal with respect to detect recurrent gastric carcinoma in anastomotic stoma and MRI is betterthan X-ray barium meal to detect recurrent gastric carcinoma in anastomotic stoma (χ2=4.90, P < 0.05). There were no significant differences between MRI and gastroscope with respect to detect recurrent gastric carcinoma in anastomotic stoma (χ2=0.03, P > 0.05). In examination of recurrent gastric carcinoma including adjacent tissue infiltration and remote metastasis, MRI shows statistical differences with X-ray barium meal(χ2=12.46, P < 0.05)and gastroscopy(χ2=5.26, P < 0.05).
    Conclusions MRI had good diagnostic performance in identifying recurrent gastric carcinoma, which is better than X-ray barium meal and gastroscope examinations. It plays an important role in directing clinical therapy and is helpful to improve postoperative survival rate of gastric carcinoma.

     

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