CT在食管癌淋巴结转移放疗靶区勾画中的价值探讨

目的探讨CT在食管癌淋巴结转移放疗靶区勾画中的价值。方法回顾性分析48例CT资料完整的食管癌术后患者，对CT扫描淋巴结转移靶区的勾画与术后病理提示淋巴结转移靶区的勾画进行比较，分析肿瘤不同位置（锁骨上、食管气管沟、后纵隔、气管旁、主动脉下、前纵隔、隆突下、食管旁、肺韧带、气管支气管、肺内、横膈、贲门旁、胃左、肝总、脾门及腹膜后）及不同区域（1-4、5-6、7、8-10和胃左淋巴结及腹主动脉旁）的术前CT检查与术后病理检查结果并比较两种方法的吻合度。结果两种方法在食管旁、胃左和腹膜后、1-4区域、8～10区域、胃左淋巴结及腹主动脉旁区域淋巴结转移的检查结果差异有统计学意义（P〈0．05）；且在锁骨上、后纵隔、前纵隔、肺韧带、横膈、肝总和脾门淋巴结转移的检查结果吻合度较强，在食管气管沟、气管支气管和贲门旁的吻合度一般，在气管旁、主动脉下、隆突下、食管旁、胃左和腹膜后及以上区域的吻合度较弱。结论CT在食管癌淋巴结转移放疗靶区勾画中有良好的价值，但在部分区域应结合腔内超声及PET-CT等检查。

Value of CT in radiotherapy target delineation of lymph node metastasis of esophageal cancer.

Objective To evaluate the value of CT in radiotherapy target delineation of lymph node metastasis of esophageal cancer. Methods In a retrospective analysis, 48 patients with esophageal cancer after operation with CT data were enrolled. Pathological findings were compared with the CT findings in target delineation. The results and consistencies of both methods on different locations （supraclavicular, tracheoesophageal groove, posterior mediastinum, paratracheal, subaortic, anterior mediastinum, snbcarinal, paraesophageal, pulmonary ligament, tracheo-bronchial, lungs, diaphragma, cardia side, left gastric, total liver, splenic hilum and retroperitoneal） and regions （1--4, 5-6, 7, 8-10 and the left gastric and abdominal para-aortic） were analyzed. Results Statistically significant differ- ences were found between both methods on paraesophageal, left gastric and retroperitoneal as well as region of 1 4, 5-6 and left gastric and abdominal para-aortic （P〈0.05）. There were strong consistencies on upraclavicular, posterior mediastinum, anterior mediastinum, pulmonary ligament, diaphragma, total liver and splenic hilum, moderate consistencies on tracheoesophageal groove, tracheobronchial and cardia side, and weak consistencies on paratracheal, subaortic, subcarinal, paraesophageal, left gastric, retroperitoneal and the above regions between both methods. Conclusion CT for lymph node metastasis is considered valuable in the radiotherapy target delineation. Although there are strong consistencies on some locations, significant differences still can be observed on paraesophageal, left gastric and retroperitoneal as well as region of 1-4, 5-6 and left gastric and abdominal pa- ra-aortic when compared with pathological findings. So CT examination combined with intracardiac echocardiography and PET-CT are necessary for the diagnosis of the loeatuin with weak consistencies.