MRI增强在Siewert II/III型食管胃结合部腺癌术前评估中的价值

目的：评估MR增强检查对于Siewert II/III型食管胃结合部腺癌术前在诊断的价值。方法：回顾性的分析我院2018年1月至2020年5月,术后病理结果证实为Siewert II/III型食管胃结合部腺癌的患者80人,经剔除后入组77人,其中男性70人,女性7人,平均年龄65.5±8.8岁,中位年龄68岁。术前一周内行影像学检查,只行CT增强检查28人,只行MR增强检查9人,同时行CT及MR增强检查（间隔1天）40人,获得术前CT增强检查图像67例,术前MR增强图像49例。由两位高年资主治医生盲法分别对CT增强及MR增强图像,进行测量及诊断,对照两种检查的结果与病理结果的一致性。类比两种检查,评估术前MR增强对于Siewert II/III型食管胃结合部腺癌的诊断价值。结果：行MR增强检查的49例食管胃结合部腺癌患者中,Siewert II型27例,Siewert III型22例,诊断正确44例;Kappa=0.791,P<0.001,MR增强检查与病理结果有高度的一致性。行CT增强检查的67例食管胃结合部腺癌患者中,Siewert II型35例,Siewert III型32例,诊断正确56例;Kappa=0.672,P<0.001,CT增强检查与病理结果有较高的一致性。对比可见,MR增强检查术前诊断食管胃结合部腺癌的Siewert分型结果,与病理结果一致性比CT检查更高。关于淋巴结转移的N分期,术前MR增强检查提示的阳性转移淋巴结与术后病理结果对比,Kappa=0.115,P<0.001,一致性欠佳;CT增强检查提示的阳性转移淋巴结与术后病理结果对照,Kappa=-0.129,P<0.001,基本无一致性。但其中MR增强检查提示阳性转移淋巴结的分组区域结果与病理结果准确率为61.70%(29/47),高于CT增强检查40.58%（28/69）。结论：以病理结果为标准,术前MR增强检查相较于CT增强检查,Siewert分型结果的一致性更高;虽然对于术前N分期,CT增强检查与病理结果无一致性,MR增强检查与病理结果一致性较差;但MR检查提示的阳性转移淋巴结分组区域的准确性高于CT增强检查。故而,MR增强检查对于Siewert II/III型食管胃结合部腺癌的术前评估,可为临床治疗方法、手术路径的选择及淋巴结清扫范围,较CT增强检查可提供更有利的证据,具有一定的术前评估价值。

The value of MRI dynamic enhancement in the preoperative evaluation of Siewert type II/III adenocarcinoma of esophagogastric junction

Objective To evaluate the value of enhanced MR examination for the preoperative diagnosis of Siewert II/III adenocarcinoma of esophagogastric junction. Method Retrospective analysis from January 2018 to May 2020, 80 patients with type Siewert II/III esophagogastric junction adenocarcinoma were confirmed by postoperative pathology. After Culling, 77 patients were enrolled, including 70 males and 7 females, the mean age was 65.5 ± 8.8 years and the median age was 68 years. All patients underwent imaging examination within one week before the operation, 28 people only underwent CT enhancement examination, 9 people only underwent MR enhancement examination, and 40 people underwent CT and MR enhancement examination at the same time (1 day interval).Then we can obtain 67 cases of preoperative CT enhanced examination images and 49 cases of preoperative MR enhanced images. Two senior attending doctors used double-blind methods to measure and diagnose CT enhanced and MR enhanced images respectively. Compared with the consistency of the results of preoperative MR enhancement examination and CT enhancement examination with the pathological results, the two examinations were compared to evaluate the diagnostic value of preoperative MR enhancement for Siewert type II/III adenocarcinoma of esophagogastric junction. Results Among 49 patients with adenocarcinoma of esophagogastric junction who underwent enhanced MR examination, 27 cases were Siewert type II, 22 cases were Siewert type III, and 44 cases were correctly diagnosed; Kappa=0.791, P<0.001, the results of enhanced MR examination and pathology were good High consistency. Among 67 patients with esophagogastric junction adenocarcinoma who underwent enhanced CT examination, 35 cases were Siewert type II, 32 cases were Siewert type III. The comparison shows that the Siewert classification results of the preoperative diagnosis of esophagogastric junction adenocarcinoma by MR examination are more consistent with the pathological results than CT examination. As for N staging of lymph node metastasis, kappa = 0.115, P < 0.001 showed poor consistency between the positive lymph nodes detected by preoperative enhanced MR and postoperative pathological results. Kappa = -0.129, P < 0.001, there was no consistency between the positive lymph nodes detected by enhanced CT and postoperative pathological results. However, the regional grouping results of positive metastatic lymph nodes suggested by MR enhancement examination were compared with the pathological results, and the accuracy rate was 61.70% (29/47), which was higher than CT enhancement by 40.58% (28/69). Conclusion Based on the pathological results, the preoperative MR enhancement examination is more consistent than the Siewert classification results of the CT enhancement examination, and the accuracy of the positive metastatic lymph node grouping area is also higher than that of the CT examination. Therefore, in the case of Siewert II/III type adenocarcinoma of the esophagogastric junction, MR contrast-enhanced imaging can provide evidence for the choice of clinical treatment, surgical approach and the extent of lymph node dissection.