Dragani M, Ciccotosto C, Storto M L, Mascitelli E, Santarelli G, Bonomo L
Istituto di Scienze Radiologiche, Università, Chieti.
Radiol Med. 1992 Oct;84(4):372-8.
The staging of bronchogenic carcinoma is an important factor to select the appropriate treatment. Indeed, the definition of locoregional spread and of hilar and mediastinal node involvement is essential for both correct preoperative assessment and prognostic evaluation of bronchogenic carcinoma. CT and MR imaging are the methods of choice in the evaluation of T and N, even though other techniques--e.g., US and nuclear medicine--can also provide valuable diagnostic information. The authors examined 50 patients with primary bronchogenic carcinoma by means of plain radiographs, CT and MR of the chest. MR and CT findings were compared with surgical results on the basis of TNM classification. In the evaluation of T, sensitivity and specificity were 66% and 88.6%, respectively, for CT and 76% and 92% for MR imaging. No statistically significant differences were found between the two imaging methods (p = 0.19). In the evaluation of N, sensitivity and specificity were 56% and 78%, respectively, for CT and 76% and 88% for MR imaging. A statistically significant difference was found between MR and CT accuracy rates (p = 0.934). CT and MR results were in disagreement especially in the evaluation of hilar lymph nodes. To date, MR imaging cannot be considered a substitute for or a routine adjunct to CT in the staging of bronchogenic carcinoma due to its poor spatial resolution, to the presence of artifacts (especially with high-intensity fields), its cost and limited availability. However, in the evaluation of specific anatomical regions--e.g., the pulmonary apex and the peridiaphragmatic region--MR can provide more diagnostic information than CT thanks to its multiplanarity and better contrast resolution.
支气管源性癌的分期是选择合适治疗方法的重要因素。实际上，明确局部区域扩散以及肺门和纵隔淋巴结受累情况对于支气管源性癌的正确术前评估和预后评估都至关重要。CT和MR成像虽是评估T和N分期的首选方法，不过其他技术，如超声和核医学，也能提供有价值的诊断信息。作者通过胸部X线平片、CT和MR对50例原发性支气管源性癌患者进行了检查。根据TNM分类，将MR和CT检查结果与手术结果进行了比较。在评估T分期时，CT的敏感度和特异度分别为66%和88.6%，MR成像的敏感度和特异度分别为76%和92%。两种成像方法之间未发现统计学显著差异（p = 0.19）。在评估N分期时，CT的敏感度和特异度分别为56%和78%，MR成像的敏感度和特异度分别为76%和88%。MR和CT的准确率之间存在统计学显著差异（p = 0.934）。CT和MR结果不一致，尤其在评估肺门淋巴结时。迄今为止，由于MR成像空间分辨率差、存在伪影（尤其是在高强度区域）、成本高且可用性有限，在支气管源性癌分期中不能将其视为CT的替代方法或常规辅助手段。然而，在评估特定解剖区域，如肺尖和膈周区域时，由于MR具有多平面性和更好的对比分辨率，它能比CT提供更多诊断信息。
