曾威龙 张华峰

【摘要】 目的：對比磁共振成像与多层螺旋CT对胃癌术前N分期及淋巴结转移的诊断效果。方法：选择本院2019年1-10月收治的66例胃癌患者为观察对象。患者在术前均进行MRI及MSCT诊断，对比MRI及MSCT对胃癌术前N分期的诊断情况，对比MRI及MSCT对患者淋巴结转移情况的有关诊断参数，以及患者淋巴结转移的ROC曲线。结果：MRI及MSCT对患者术前N分期的诊断结果对比，差异无统计学意义（P>0.05）。MRI显示淋巴结转移组患者的rADC明显低于淋巴结未转移组，而MSCT显示淋巴结转移组患者的强化程度明显高于淋巴结未转移组（P<0.05）。经ROC曲线分析发现，MRI诊断患者淋巴结转移的rADC阈值为0.77时曲线下面积为0.813，敏感度为78.50%，特异度为54.83%。MSCT诊断患者淋巴结转移的强化程度阈值为36.14 HU时曲线下面积为0.879，敏感度为77.24%，特异度为91.98%。结论：应用MRI的rADC值及MSCT的强化程度均可对胃癌术前N分期及淋巴结转移产生较好的诊断价值。

【关键词】 磁共振成像 多层螺旋CT N分期 淋巴结转移

Comparative Analysis of Preoperative N Staging and Lymph Node Metastasis of Gastric Cancer by Magnetic Resonance Imaging and Multislice Spiral CT/ZENG Weilong， ZHANG Huafeng. //Medical Innovation of China， 2021， 18（07）： 0-044

[Abstract] Objective： To compare the diagnostic effect of magnetic resonance imaging （MRI） and multislice spiral CT （MSCT） in preoperative N staging and lymph node metastasis of gastric cancer. Method： A total of 66 patients with gastric cancer admitted to our hospital from January to October 2019 were selected as the observation objects. All patients were diagnosed by MRI and MSCT before operation. The preoperative N staging diagnosis of gastric cancer by MRI and MSCT， the diagnostic parameters of lymph node metastasis by MRI and MSCT， and the ROC curve of lymph node metastasis were compared. Result： There was no significant difference between MRI and MSCT in preoperative N staging （P>0.05）. MRI showed that the rADC of the patients with lymph node metastasis was significantly lower than that of the group without lymph node metastasis， while MSCT showed that the degree of enhancement of the patients with lymph node metastasis was significantly higher than that of the group without lymph node metastasis （P<0.05）. ROC curve analysis showed that the area under the curve was 0.813 when the rADC threshold was 0.77， the sensitivity was 78.50%， and the specificity was 54.83%. The area under the curve was 0.879， the sensitivity was 77.24%， and the specificity was 91.98% when the enhancement threshold of 36.14 HU was diagnosed by MSCT. Conclusion： The rADC value of MRI and the enhancement degree of MSCT can be used in the diagnosis of preoperative N staging and lymph node metastasis of gastric cancer.

[Key words] Magnetic resonance imaging Multislice spiral CT N stage Lymph node metastasis

First-authors address： Sun Yat-sen University Cancer Center， Guangzhou 510060， China

doi：10.3969/j.issn.1674-4985.2021.07.010

随着医学影像科技的不断发展，当前诊断胃癌的影像学方式也逐渐增多，其中有代表性的主要是MRI及MSCT等方式，这两种诊断方式对于胃癌术前的TNM分期也具有较高的应用价值[1-2]。然而，由于MRI的常规扫描具有较大的层厚，因此以往认为在针对较小的淋巴结检查上，MSCT相对更具优势。扩散加权成像可从分子水平对组织内的有关水分子自身弥散运动的特性进行反映[3]，并通过ADC对于扩散程度实施量化，对发生淋巴结转移的情况实施诊断。本文对比MRI与MSCT对胃癌术前N分期及淋巴结转移的诊断情况，旨在为临床诊断方案提高参考，现报道如下。

1 资料与方法

1.1 一般资料 选择本院2019年1-10月收治的66例胃癌患者为观察对象，其中男39例，女27例;年龄32～79岁，平均（54.64±2.31）岁。N分期：N1 6例，N2 9例，N3a 37例，N3b 14例。纳入标准：（1）患者均由术后病理证实;（2）均实施MRI及MSCT诊断者;（3）诊断前未接受治疗者。排除……