Arslan Harun, Fatih Özbay Mehmet, Çallı İskan, Doğan Erkan, Çelik Sebahattin, Batur Abdussamet, Bora Aydın, Yavuz Alpaslan, Bulut Mehmet Deniz, Özgökçe Mesut, Çetin Kotan Mehmet
YuzuncuYil University DursunOdabas Medical Center, Department of Radiology, Van, Turkey.
Van Training and Research Hospital, Department of İnternal Medicine, Van, Turkey.
Radiol Oncol. 2017 Feb 22;51(1):23-29. doi: 10.1515/raon-2017-0002. eCollection 2017 Mar 1.
Diagnostic performance of Diffusion-Weighted magnetic resonance Imaging (DWI) and Multi-Detector Computed Tomography (MDCT) for TNM (Tumor, Lymph node, Metastasis) staging of gastric cancer was compared.
We used axial T2-weighted images and DWI (b-0,400 and b-800 s/mm2) protocol on 51 pre-operative patients who had been diagnosed with gastric cancer. We also conducted MDCT examinations on them. We looked for a signal increase in the series of DWI images. The depth of tumor invasion in the stomach wall (tumor (T) staging), the involvement of lymph nodes (nodal (N) staging), and the presence or absence of metastases (metastatic staging) in DWI and CT images according to the TNM staging system were evaluated. In each diagnosis of the tumors, sensitivity, specificity, positive and negative accuracy rates of DWI and MDCT examinations were found through a comparison with the results of the surgical pathology, which is the gold standard method. In addition to the compatibilities of each examination with surgical pathology, kappa statistics were used.
Sensitivity and specificity of DWI and MDCT in lymph node staging were as follows: N1: DWI: 75.0%, 84.6%; MDCT: 66.7%, 82%;N2: DWI: 79.3%, 77.3%; MDCT: 69.0%, 68.2%; N3: DWI: 60.0%, 97.6%; MDCT: 50.0%, 90.2%. The diagnostic tool DWI seemed more compatible with the gold standard method (surgical pathology), especially in the staging of lymph node, when compared to MDCT. On the other hand, in T staging, the results of DWI and MDCT were better than the gold standard when the T stage increased. However, DWI did not demonstrate superiority to MDCT. The sensitivity and specificity of both imaging techniques for detecting distant metastasis were 100%.
The diagnostic accuracy of DWI for TNM staging in gastric cancer before surgery is at a comparable level with MDCT and adding DWI to routine protocol of evaluating lymph nodes metastasis might increase diagnostic accuracy.
比较弥散加权磁共振成像（DWI）和多排螺旋计算机断层扫描（MDCT）对胃癌TNM（肿瘤、淋巴结、转移）分期的诊断效能。
对51例术前诊断为胃癌的患者采用轴位T2加权像及DWI（b值为0、400和800 s/mm²）扫描方案，并对其进行MDCT检查。观察DWI图像序列中信号增强情况。根据TNM分期系统评估DWI和CT图像中肿瘤侵犯胃壁的深度（肿瘤（T）分期）、淋巴结受累情况（淋巴结（N）分期）以及有无转移（转移分期）。在肿瘤的各项诊断中，通过与作为金标准方法的手术病理结果进行比较，得出DWI和MDCT检查的敏感度、特异度、阳性和阴性准确率。除了各项检查与手术病理的一致性外，还采用了kappa统计分析。
DWI和MDCT在淋巴结分期中的敏感度和特异度如下：N1期：DWI为75.0%、84.6%；MDCT为66.7%、82%；N2期：DWI为79.3%、77.3%；MDCT为69.0%、68.2%；N3期：DWI为60.0%、97.6%；MDCT为50.0%、90.2%。与MDCT相比，诊断工具DWI似乎与金标准方法（手术病理）更具一致性，尤其是在淋巴结分期方面。另一方面，在T分期中，当T分期增加时，DWI和MDCT的结果优于金标准。然而，DWI并未显示出优于MDCT。两种成像技术检测远处转移的敏感度和特异度均为100%。
术前DWI对胃癌TNM分期的诊断准确性与MDCT相当，在评估淋巴结转移的常规方案中增加DWI可能会提高诊断准确性。
