多层螺旋CT和MRI对直肠癌术前TN分期的比较研究

目的分析比较直肠癌患者术前64排螺旋CT和1.5T磁共振常规增强检查局部TN分期的准确性,探讨两种检查方法对术前直肠癌分期的价值。方法收集经术后病理证实为直肠癌患者的术前64排多层螺旋CT检查资料和1.5 T MR检查资料各30例。统计分析CT和MR检查的TN分期结果与病理TN分期结果的一致率,比较两种检查方法对术前直肠癌分期的价值。采用一致率的Kappa值检验,两个样本率的x~2检验(Fisher's精确检验)。结果 CT诊断T分期结果与术后病理诊断的T分期结果存在一致性,且一致性较好(Kappa=0.543,P=0.000),而CT诊断N分期结果与术后病理诊断N分期结果的一致性较差(Kappa=0.167,P=0.283)。MR诊断T分期结果与术后病理诊断的T分期结果存在一致性,且一致性较好(Kappa=0.607,P=0.000),MR诊断N分期结果与术后病理诊断N分期结果的一致性亦较好(Kappa=0.466,P=0.000)。CT诊断T分期结果与术后病理诊断T分期结果的一致率和MR诊断T分期结果与术后病理诊断T分期结果的一致率无统计学差异(x~2=1.000,P=0.833)。结论常规64排多层螺旋CT和MR检查是直肠癌患者术前分期的可靠、优势检查手段。对于T分期,二者各有优势,而对于N分期,MR检查优于64排多层螺旋CT检查。

Comparison study of multi-slice CT and MRI in the preoperative TN staging of rectal cancer

Objective To compare the pre-operative staging accuracy of contrast-enhanced CT and MRI for rectal cancer. Methods 64-detector-row CT of 30 patients and the 1.5 T MRI of 30 patients with pathologically confirmed rectal were retrospectively analyzed.The tumor（T）and nodal（N）staging concordance rates of CT and MR with pathology were compared usingκandχ2 values. Results The concordance was good between the T staging（κ=0.543,P=0）and poor between the N staging（κ=0.167,P=0.283） of CT and pathology.The concordance was good between the T staging（κ=0.607,P=0）and N staging（κ=0.466,P=0）of MRI and pathology.The T staging concordance rates of CT and MRI were not significantly different（χ2=1.000,P=0.833）.Conclusion Both CT and MRI are reliable for preoperative T staging whereas MRI is superior to CT for N staging of rectal cancer.