Department of Radiology, Seoul National University College of Medicine and the Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul 110-744, Korea.
Korean J Radiol. 2010 Jan-Feb;11(1):37-45. doi: 10.3348/kjr.2010.11.1.37. Epub 2009 Dec 28.
We wanted to determine the clinical feasibility of using non-breath-hold real-time MR-echo imaging for the evaluation of mediastinal and chest wall tumor invasion.
MR-echo imaging was prospectively applied to 45 structures in 22 patients who had non-small cell lung cancer when the tumor invasion was indeterminate on CT. The static MR imaging alone, and the static MR imaging combined with MR-echo examinations were analyzed. The surgical and pathological findings were compared with using the Wilcoxon-signed rank test and McNemar's test.
The accuracy, sensitivity and specificity of the combined MR-echo examination and static MR imaging for determining the presence of invasion were 84%, 83% and 85%, respectively, for the first reading session and they were 87%, 83% and 87%, respectively, for the second reading session (there was substantial interobserver agreement, k = 0.74). For the static MR imaging alone, these values were 62%, 83% and 59%, respectively, for the first reader and they were 69%, 67% and 74%, respectively, for the second reader (there was moderate interobserver agreement, k = 0.49). The diagnostic confidence for tumor invasion was also higher for the combined MR-echo examination and static MR imaging than that for the static MR imaging alone (p < 0.05).
The combined reading of a non-breath-hold real-time MR-echo examination and static MR imaging provides higher specificity and diagnostic confidence than those for the static MR imaging reading alone to determine the presence of mediastinal or chest wall tumor invasion when this was indeterminate on CT scanning.
我们旨在确定使用非屏气实时磁共振回波成像评估纵隔和胸壁肿瘤侵犯的临床可行性。
前瞻性地将磁共振回波成像应用于 22 例非小细胞肺癌患者的 45 个结构，当 CT 扫描不能确定肿瘤侵犯时，这些结构包括纵隔和胸壁肿瘤。单独进行静态磁共振成像和静态磁共振成像结合磁共振回波检查进行分析。手术和病理结果与使用 Wilcoxon 符号秩检验和 McNemar 检验进行比较。
联合磁共振回波检查和静态磁共振成像对确定侵犯存在的准确性、敏感性和特异性分别为首次读片时的 84%、83%和 85%，第二次读片时为 87%、83%和 87%（观察者间存在实质性一致性，k = 0.74）。对于单独的静态磁共振成像，第一次读片时的这些值分别为 62%、83%和 59%，第二次读片时为 69%、67%和 74%（观察者间存在中度一致性，k = 0.49）。对于肿瘤侵犯的诊断信心，联合磁共振回波检查和静态磁共振成像也高于单独使用静态磁共振成像（p < 0.05）。
当 CT 扫描不能确定纵隔或胸壁肿瘤侵犯时，非屏气实时磁共振回波检查和静态磁共振成像的联合阅读比单独进行静态磁共振成像阅读提供更高的特异性和诊断信心，以确定肿瘤侵犯的存在。
