食管癌：3.0T 高空间分辨率 T 映射磁共振成像与组织病理学结果的离体评估
Esophageal carcinoma: Ex vivo evaluation by high-spatial-resolution T -mapping MRI compared with histopathological findings at 3.0T.
作者信息
Wei Yi, Wu Sen, Gao Feifei, Sun Tingyi, Zheng Dandan, Ning Peigang, Zhao Cuihua, Li Ziyuan, Li Xiaodong, Li Linlin, Zhu Shaocheng
机构信息
Department of Radiology, Zhengzhou University People's Hospital, Zhengzhou, China.
Department of Radiology, Henan Provincial People's Hospital, Zhengzhou, China.
出版信息
J Magn Reson Imaging. 2017 Jun;45(6):1609-1616. doi: 10.1002/jmri.25509. Epub 2016 Oct 6.
PURPOSE
To prospectively determine the feasibility of T -mapping magnetic resonance imaging (MRI) to quantitatively describe the signal characteristics of the normal esophageal wall and assess the depth of esophageal wall invasion by carcinoma at 3.0T.
MATERIALS AND METHODS
Thirty-two patient specimens, each having foci of carcinoma, were studied using 3.0T MR. Freehand regions of interest were placed to measure the T value of the normal esophageal layers and were compared with the regions of carcinoma. Three independent readers reviewed the MR images to evaluate the depth of carcinoma invasion; when the three radiologists could not fully agree with each other, the final stage was determined by consensus. The Games-Howell test was used to compare the difference between the normal esophageal layers and carcinoma. Spearman correlation coefficient analysis was used to compare the stage at MRI with that at histopathological analysis. The interobserver agreement was compared with Cohen's kappa. The sensitivity, specificity, and accuracy for detecting carcinoma invasion were calculated.
RESULTS
The T values between the carcinoma and normal esophageal layers were different (all P < 0.01), except for the inner circular muscle (P = 0.511). The T value of each layer of the normal esophageal wall was also different from that of the adjacent layer (all P < 0.01). In 29 of 32 lesions, the depth of the esophageal wall invasion determined by MR was consistent with the histopathological stage (r = 0.969, P < 0.001). The sensitivity, specificity, and accuracy were 80%, 96.3%, and 93.8%, respectively, for invasion into the mucosa; 77.8%, 95.7%, and 90.6%, respectively, for invasion into submucosa; 100%, 95.8%, and 96.9%, respectively, for invasion into muscularis propria; and 100%, 100%, and 100%, respectively, for invasion into the adventitia.
CONCLUSION
T -mapping MR images obtained using a 3.0T MR scanner can be used to depict the precise histopathological layers of the esophageal wall clearly and provide excellent diagnostic accuracy for assessing esophageal carcinoma invasion.
LEVEL OF EVIDENCE
1 Technical Efficacy: Stage 2 J. MAGN. RESON. IMAGING 2017;45:1609-1616.
目的
前瞻性地确定T映射磁共振成像（MRI）定量描述正常食管壁信号特征及评估3.0T条件下食管癌侵犯食管壁深度的可行性。
材料与方法
对32例含有癌灶的患者标本进行3.0T MR研究。采用徒手绘制感兴趣区测量正常食管各层的T值，并与癌灶区域进行比较。由3名独立阅片者评估MR图像以确定癌侵犯深度；当3名放射科医生意见不完全一致时，通过协商确定最终分期。采用Games-Howell检验比较正常食管层与癌灶之间的差异。采用Spearman相关系数分析比较MRI分期与组织病理学分析分期。采用Cohen's kappa检验比较观察者间的一致性。计算检测癌侵犯的敏感性、特异性和准确性。
结果
除内环肌外，癌灶与正常食管层之间的T值存在差异（均P < 0.01），内环肌的P值为0.511。正常食管壁各层的T值也与其相邻层不同（均P < 0.01）。在32个病灶中的29个中，MR确定的食管壁侵犯深度与组织病理学分期一致（r = 0.969，P < 0.001）。对于侵犯黏膜，敏感性、特异性和准确性分别为80%、96.3%和93.8%；对于侵犯黏膜下层，分别为77.8%、95.7%和90.6%；对于侵犯固有肌层，分别为100%、95.8%和96.9%；对于侵犯外膜，分别为100%、100%和100%。
结论
使用3.0T MR扫描仪获得的T映射MR图像可清晰描绘食管壁的精确组织病理学层次，并为评估食管癌侵犯提供优异的诊断准确性。
证据水平
1 技术效能：2级 J.MAGN.RESON.IMAGING 2017;45:1609 - 1616。
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