2D MRI和3D MRI序列对直肠癌术前分期诊断的价值研究

目的:评估磁共振二维T2加权自旋回波成像序列(2D-T2WI TSE)与三维T2加权自旋回波成像序列(3D-T2WI TSE,VISTA)两种成像方法在直肠癌术前分期的准确性。方法:采用飞利浦3.0T MR机扫描,由两位放射科医师独立评估,回顾性分析从2016年1月至2016年4月间经病理确诊的33例直肠癌患者的2D-MRI序列及3D VISTA扫描序列图像。运用SPSS统计软件分别分析2D序列及3D VISTA序列对直肠癌术前T、N分期的准确性,并检验诊断结果的一致性。结果:33例病例,医师1与医师2其常规2D和3D VISTA检查序列T分期的准确性分别为70%和85%(P=0.274)及73%和82%(P=0.454),Kappa分别为0.576和0.790及0.618和0.746,3D VISTA序列评估T分期与病理结果的一致性优于2D序列;其N分期的准确性分别为58%和70%(P=0.182)及58%和67%(P=0.218),Kappa分别为0.252和0.407及0.267和0.376,N分期2D及3D VISTA分期与病理结果的一致性较差。结论:2D与3D VISTA序列对直肠癌TN分期的准确性无统计学差异,但是3D VISTA较2D序列在鉴别T2与早期T3及N分期方面有一定潜在优势。 

The Value of 2D MRI and 3D MRI Sequences in Preoperative Staging of Rectal Cancer

Objective: To evaluate the accuracy of the preoperative local-regional staging of the rectal cancer by a two-dimensional (2D) T2-weighted TSE sequence and a three-dimensional (3D VISTA) T2-weighted turbo spin-echo (TSE) magnetic resonance (MR) sequence. Materials and Methods: This retrospective study was conducted of 33 patients who diagnosed rectal cancer pathologically from January to April in 2016. Two radiologists independently assessed the radiologic images for T and N staging. All patients were performed with both 2D-T2WI MRI and 3D VISTA MRI of the rectum by Philips 3.0T MR imager. The accuracy and consistence with pathological results of TN staging using 2D and 3D sequences were calculated using SPSS 23. Results: in 33 cases, T staging accuracy values of 2D and 3D VISTA data were 70% and 85% , respectively (Kappa value were 0.576 and 0.790) for reviewer 1 (P = 0.274) and 73% and 82% (Kappa value were 0.618 and 0.746) for reviewer 2 (P = 0.454), The agreement of VISTA T sequences between 3D staging and pathologic results was excellent and better than that of 2D sequences; N category lesion staging accuracy values for 2D and 3D VISTA data were 58%and 70%, respectively (Kappa value were 0.252 and 0.407) for reviewer 1 (P = 0.182) and 58% and 67% (Kappa value were 0.267 and 0.376) for reviewer 2 (P = 0.218). The agreement of N staging 2D and VISTA 3D staging with pathological results were both poor agreement. Conclusion: Preoperative staging with conventional 2D MR imaging sequence and 3D VISTA T2-weighted imaging protocols for rectal cancer patients showed no significant differences in accuracy of TN staging. However, compared to 2D sequence, 3D VISTA sequence has its advantages in preoperative MR staging.