胃癌磁共振成像术前TNM分期的临床应用价值

目的探讨磁共振成像（MRI）对胃癌患者进行术前TNM分期的临床应用价值。方法使用1.5T MRI扫描仪,对2010年12月至2012年1月泰山医学院附属莱芜医院收治的经手术病理证实的41例胃癌患者术前进行TNM分期,并与手术病理分期结果相对照。MRI与手术病理TNM分期结果一致性分析采用Kappa检验。结果本组41例胃癌患者,MRI诊断为T1期2例,T2期9例,T3期11例,T4a期15例,T4b期4例;病理诊断为T1期3例,T2期8例,T3期11例,T4a期15例,T4b期4例。本组41例胃癌患者中,2例远处转移的患者及1例姑息性手术行部分淋巴结清扫的患者不参与N分期的对照研究。本组评价的38例胃癌患者,MRI诊断为N0期14例,N1期14例,N2期10例;病理诊断为N0期16例,N1期9例,N2期13例。本组41例胃癌患者,MRI诊断为M0期37例,M1期4例;病理诊断为M0期37例,M1期4例。本组胃癌患者MRI进行T、N、M分期总的准确率分别为73.17%（30/41）、71.05%（27/38）、95.12%（39/41）。本组胃癌患者MRI与手术病理T分期、N分期结果一致性较好（Kappa=0.637、0.566）,本组胃癌患者MRI与手术病理M分期结果具有高度一致性（Kappa=0.910）。结论 MRI对胃癌术前TNM分期具有一定优势,特别是T4分期和M分期的准确率较高。

Clinical application value of TNM staging of gastric carcinoma by magnetic resonance imaging

Objective To investigate the clinical value of TNM staging of gastric cancer with magnetic resonance imaging（ MRI）. Methods TNM stages of 41 patients with gastric cancer confirmed by pathology from December 2010 to January 2012 in Laiwu People＇ s Hospital Affiliated to Taishan Medical College were studied with 1. 5T MRI,and were compared with the pathological staging. The consistency of results was analysed with Kappa testing. Results In all the cases,the cases numbers of T1,T2,T3,T4a and T4b diagnosed by MRI were 2,9,11,15 and 4,and those diagnosed by pathology were 3,8,11,15and 4,respectively. Two cases with distant metastasis and 1 case who underwent palliative operation of lymph nodes cleaning were not fit into the study of N stage. In the 38 cases,the cases numbers of N0,N1and N2 diagnosed by MRI were 14,14 and 10,and those diagnosed by pathology were 16,9 and 13. In the41 cases,the cases numbers of M0 and M1 diagnosed by MRI were 37 and 4,and those diagnosed by pathology were 37 and 4. The total accuracies of MRI for T stage,N stage,M stage were 73. 17%（ 30 /41）,71. 05%（ 27 /38）,95. 12%（ 39 /41）. The T and N stages results of MRI and pathology were consistent well（ Kappa =0. 637,0. 566）,and the M stage results of MRI and pathology were consistent very well each other（ Kappa = 0. 910）. Conclusions MRI has certain advantages in evaluating TNM stage of gastric cancer before operation,especially in T4 stage and M stage.