3.0 T MRI对新辅助化疗后食管癌术前T分期的准确性及组织病理学相关性
1 东南大学附属中大医院江北院区肿瘤科，南京 210044
2 江苏省肿瘤医院放疗科，南京 210009
目的：探讨3.0 T磁共振成像对新辅助化疗食管癌术前T分期及组织病理学分期一致性的价值。方法：前瞻性纳入2017年1月至2018年12月期间79例食管癌患者。患者均接收2周期新辅助化疗后再接收3.0 T MRI检查及根治性手术。2位不同的阅片人员分别对T2加权TSE BLADE、增强StarVIBE、高分辨率StarVIBE延迟扫描上病灶T分期进行判断。结果：新辅助化疗结束至MRI检查间隔时间为(23±2) d。在T2加权TSE BLADE扫描中，2位阅片人的判断准确性最高(κ=0.810，P<0.0001)。T2加权TSE BLADE、增强StarVIBE、高分辨率StarVIBE延迟扫描对术后组织病理学T分期的诊断准确率分别为86.1%~96.2%，86.1%~94.9%，86.1%~96.2%。高分辨率StarVIBE延迟扫描在对T0，T1，T2，T4的判断价值最高，而T2加权TSE BLADE对T3病变的判断价值最高。结论：除T3期病变外，T2加权TSE BLADE序列在明确新辅助化疗后食管癌病变T分期方面具有更高的精准度。T2加权TSE BLADE、增强StarVIBE和高分辨率StarVIBE延迟扫描三者联合不能进一步提高诊断准确性。
Accuracy of 3.0 T MRI for preoperative T staging of esophageal cancer after neoadjuvant chemotherapy and its relation with histopathology
CorrespondingAuthor: ZHAO Feng
This work was supported by Jiangsu Provincial Health and Family Planning Commission 2017 Medical Research Project, China (H201708).
Objective: To explore the value of 3.0T MRI for evaluating the preoperative T staging of esophageal cancer (EC) treated with neoadjuvant chemotherapy (NAC), with histopathologic confirmation. Methods: A total of 79 patients with EC from January 2017 to December 2018 were prospectively included. All patients received 2 cycles of NAC. After NAC, all patients received 3.0 T MRI examination and radical surgery. Two different reviewers judged the T staging of lesions on T2-weighted TSE BLADE, enhanced StarVIBE and high resolution StarVIBE delayed scanning respectively. Results: The average interval between the end of NAC and the examination of MRI was (23±2) d. Interbreeder agreements of T category assignment were highest for T2-weighted TSE BLADE (κ=0.810, P<0.0001). The diagnostic accuracy of T2-weighted TSE BLADE, enhanced StarVIBE and high-resolution StarVIBE delayed scanning for T-staging was 86.1%–96.2%, 86.1%–94.9%, 86.1%–96.2%, respectively. High-resolution StarVIBE delayed scan has the highest value in judging T0, T1, T2 and T4, while T2-weighted TSE BLADE has the highest value in judging T3 lesions. Conclusion: High-resolution delayed phase StarVIBE had the highest diagnostic accuracy in staging EC after NAC for all T categories except T3, for which T2-weighted TSE BLADE had the highest accuracy. Combining all three sequences did not improve diagnostic accuracy.
esophageal cancer; T2-weighted turbo spin-echo BLADE; contrast-enhanced StarVIBE; high-resolution delayed phase StarVIBE