本文選題：食管癌　切入點：高分辨成像　出處：《鄭州大學》2017年碩士論文　論文類型：學位論文

【摘要】：背景和目的:食管癌在世界惡性腫瘤中發(fā)病率排名第八位。然而,由于其術前分期晚且缺乏準確的術前分期手段,因此預后較差。CT常用于評價食管癌對周圍組織結構侵犯及遠處轉移,但由于其軟組織分辨率較低,不能準確判定管壁浸潤深度。超聲內(nèi)鏡可準確判定食管癌黏膜內(nèi)及黏膜下侵犯,但由于其探測范圍有限,對食管壁固有肌層及外膜浸潤的判定仍有其局限性。文獻報道,磁共振成像能用于食管癌管壁浸潤深度的評估,有望替代CT和超聲內(nèi)鏡作為食管癌精準分期的影像學檢查方法。因此本研究旨在探討3.0 T MR食管癌成像在食管癌分期診斷中的應用價值。第一部分離體食管癌標本3.0 T磁共振高分辨成像與病理對照研究目的:探討3.0 T磁共振高分辨成像正常食管壁信號特征及對食管癌精準分期的診斷價值材料和方法:使用小動物線圈對經(jīng)胃鏡活檢證實的95例離體食管癌標本行3.0 T磁共振高分辨成像。由兩名影像診斷醫(yī)師采用隨機、獨立、盲法對離體食管癌標本MR圖像進行分析并分別做出影像學分期,當兩名醫(yī)師意見分歧時經(jīng)協(xié)商達成一致。匹配相對應的磁共振斷層圖像和病理圖像,對比食管癌磁共振影像分期與病理分期。用Kappa一致性檢驗比較磁共振影像分期與病理分期以及兩名觀察者之間的一致性;靈敏度、特異度、準確度用于評價3.0 T磁共振影像精準分期的診斷效能。結果:3.0 T MR高分辨成像可顯示正常食管壁8層組織解剖學結構,磁共振圖像顯示的信號分層與食管壁的組織學分層一一對應。95例中86例磁共振影像分期與病理分期一致(90.5%,86/95),一致性較高(Kappa值=0.870)。MR高分辨率成像對T1a期食管癌診斷的敏感度、特異度和準確度分別為76.9%、97.6%和94.7%;對T1b期診斷的上述指標分別為80.6%、95.3%和90.5%;對T2期診斷的上述指標分別為100%、94.2%和95.8%;對T3期及以上分期診斷的上述指標分別為100%、100%和100%。結論:3.0 T MR高分辨成像能夠顯示正常食管壁組織學分層,對離體食管癌標本的分期診斷具有較好的靈敏度、特異度和準確度。第二部分離體食管癌標本高分辨T2-mapping成像與病理對照研究目的:采用T2-mapping成像對正常食管壁不同分層及食管癌的信號特征進行定量分析,評價食管癌管壁浸潤深度,并與相應的組織病理學層面進行對照。材料和方法:前瞻性納入52例新鮮離體食管癌標本行3.0 T MR成像,測量正常食管壁不同分層及腫塊的T2值。由三名影像診斷醫(yī)師隨機、獨立、盲法進行磁共振影像分期,當意見分歧時經(jīng)協(xié)商達成一致。匹配相對應的磁共振斷層影像與病理圖像,對比食管癌磁共振影像分期與病理分期。Games-Howell檢驗用于比較正常食管壁不同分層間及其與腫塊間T2值的差異。Spearman相關系數(shù)用于比較磁共振影像與病理分期相關性。三名觀察者之間的一致性比較采用kappa一致性檢驗;靈敏度、特異度、準確度、陽性預測值、陰性預測值用于評價磁共振影像精準分期的診斷效能。結果:高分辨T2-mapping成像可顯示正常食管壁8層組織解剖學結構。T2-mapping圖像所顯示解剖分層與正常食管壁的組織學分層一一對應。除內(nèi)環(huán)肌外(P=0.790),正常食管壁不同解剖分層間、正常食管壁不同分層與腫塊的T2值間差異具有統(tǒng)計學意義(P0.01)。52例中47例磁共振影像分期與病理分期一致,過高分期3例,過低分期2例,MRI分期和與病理分期一致(90.4%,47/52),一致性較高(r=0.968,P0.01)。MR高分辨率成像對T1a期食管癌診斷的敏感度、特異度和準確度分別為75%,95.5%和92.3%;對T1b期診斷的上述指標分別為80%,94.6%和90.4%;對T2期診斷的上述指標分別為100%,97.4%和98.1%,對T3/T4期診斷的上述指標分別為為100%,100%和100%。結論:3.0 T MR高分辨T2-mapping成像能夠對正常食管壁不同組織學分層及腫瘤的信號特征進行定量分析,對食管癌管壁浸潤深度的判定具有較高的靈敏度、特異度和準確度。第三部分3.0 T MR高分辨成像食管癌術前分期與病理對照研究目的:探討3.0 T MR高分辨成像對食管癌術前分期診斷的價值。材料和方法:前瞻性連續(xù)性納入經(jīng)胃鏡活檢證實,并行3.0 T MR成像,且手術切除的食管癌患者135例。由三名影像診斷醫(yī)師進行MRI分期,當意見分歧時經(jīng)協(xié)商達成一致;一名病理診斷醫(yī)師進行病理分期。同時測量腫瘤最大橫徑處腫塊的厚度。kappa一致性檢驗用于評價MRI分期與病理分期及三名影像診斷醫(yī)師分期間的一致性。以病理結果為金標準,計算食管癌MRI分期的靈敏度、特異度、準確度。Bland-Altman散點圖用于比較三名影像診斷醫(yī)師之間以及他們分別與病理診斷醫(yī)師之間所測量腫塊厚度的一致性。結果:109例食管癌患者MRI分期與病理分期一致(80.7%,109/135),一致性好(Kappa值=0.753)。MRI對T1a期食管癌診斷的靈敏度、特異度、準確度分別為57.1%、98.3%、94.1%(;對T1b期分別為73.9%、94.6%、91.1%;對T2期分別為76.9%、93.6%、90.4%;對T3期分別為78.4%、95.9%、91.1%;對T4a期分別為100%、95%、96.3%。Bland-Altman散點圖表明三名影像診斷醫(yī)師與病理診斷醫(yī)師間所測厚度差平均分別為2.0 mm、2.6 mm及2.1 mm;三名影像診斷醫(yī)師之間厚度差平均分別為0.6 mm、0.1 mm及0.4 mm;影像診斷醫(yī)師與病理診斷醫(yī)師間及各影像診斷醫(yī)師間測量腫塊厚度的一致性好。結論:3.0T MR高分辨率成像能夠判定食管癌管壁浸潤深度,對食管癌術前精準分期具有較大價值。
[Abstract]:Background and objective: esophageal cancer incidence rates in the world ranked eighth. However, due to the preoperative staging of late and the lack of accurate preoperative staging methods, so the poor prognosis of.CT commonly used in the evaluation of esophageal carcinoma with surrounding tissue invasion and distant metastasis, but because of its soft tissue resolution is low, can not accurately determine the wall infiltration depth. Endoscopic ultrasonography can accurately determine the esophageal mucosa and submucosal invasion, but due to the limited detection range of the esophageal wall, muscularis propria and adventitia infiltration determination still has its limitations. The literature reports, magnetic resonance imaging can be used to assess the invasion depth of esophageal cancer, is expected to replace CT and as the precise staging of esophageal cancer endoscopic ultrasound imaging method. Therefore this study aims to explore the application value of 3 T MR esophageal cancer imaging in staging diagnosis of esophageal carcinoma. The first part of the 3. standard of esophageal carcinoma in vitro 0 T high resolution magnetic resonance imaging and pathological control study objective: To explore the 3 T high resolution magnetic resonance imaging of normal esophageal wall and signal features of esophageal cancer staging accurate diagnostic value of materials and methods: the use of small animal coil on isolated esophageal cancer specimens for 3 T magnetic resonance imaging of high resolution imaging by endoscopic biopsy confirmed 95 cases by two radiologist using random, independent, blind method to analyze isolated esophageal cancer specimens and MR images were made when imaging staging, two physicians in disagreements by consensus. Matching the magnetic resonance tomographic images and pathological image contrast, magnetic resonance imaging and staging of esophageal cancer pathological staging. The consistency between the Kappa consistency test comparison of magnetic resonance imaging and pathological staging and two observers; the sensitivity, specificity and accuracy for the evaluation of 3 T magnetic resonance imaging precision stage The diagnostic efficacy. Results: 3 T high resolution MR imaging can display the anatomical structure of 8 layers of normal esophageal tissue, magnetic resonance imaging showed that the signal of stratification and esophageal wall tissue layers corresponding to.95 in 86 cases of magnetic resonance imaging and pathological staging (90.5%, 86/95), with high consistency (Kappa value =0.870).MR high resolution imaging for the diagnosis of stage T1a esophageal cancer sensitivity, specificity and accuracy were 76.9%, 97.6% and 94.7%; the index of T1b diagnosis were 80.6%, 95.3% and 90.5%; the index of T2 diagnosis were 100%, 94.2% and 95.8%; the index T3 and above staging were 100%, 100% and 100%. conclusion: 3 T high resolution MR imaging can display the school stratification of normal esophageal tissues on isolated esophageal cancer staging diagnosis has good sensitivity, specificity and accuracy. In the second part, from the body of food Tube carcinoma high resolution T2-mapping imaging and pathology of the objective: the signal characteristics of T2-mapping imaging of normal esophageal wall in different layers of esophageal cancer and quantitative analysis, evaluation of esophageal wall infiltration depth, and the corresponding pathological levels were compared. Materials and methods: 52 cases of isolated fresh esophageal cancer target the T MR imaging in 3 prospectively enrolled, measurement of normal esophageal wall in different layers of the mass and T2 value. By three radiologist random, independent, blind method for magnetic resonance imaging staging, when disagreements by consensus. The matching magnetic resonance tomographic imaging and pathology image corresponding to the magnetic contrast of esophageal cancer MR imaging and pathological staging in.Games-Howell test for comparing the difference between different layers of normal esophageal mass and T2 value of the.Spearman correlation coefficient for comparison of magnetic resonance imaging and pathology Staging correlation. The consistency between the three men were compared using kappa consistency test; sensitivity, specificity, accuracy, positive predictive value, negative predictive value for the evaluation of magnetic resonance imaging in precise staging. Results: the diagnostic efficiency of normal esophageal wall can display 8 layers of tissue anatomical structure of.T2-mapping image display and hierarchical anatomy the normal esophageal tissue layers and corresponding high resolution T2-mapping imaging. In addition to the inner muscle (P=0.790), normal esophageal wall in different anatomic layers, normal esophageal wall in different stratification and mass T2 values were statistically significant differences (P0.01) in.52 cases, 47 cases of magnetic resonance imaging and pathological staging, understaged in 3 cases, 2 cases of low stage, MRI staging and pathological staging and consistent (90.4%, 47/52), high consistency (r=0.968, P0.01).MR high resolution imaging for the diagnosis of stage T1a esophageal cancer sensitivity, specificity and The accuracies were 75%, 95.5% and 92.3%; the index of T1b diagnosis were 80%, 94.6% and 90.4%; the index of T2 diagnosis were 100%, 97.4% and 98.1%, the index of T3/T4 diagnosis were 100%, 100% and 100%. conclusion: 3 T MR high resolution signal characteristics T2-mapping imaging to normal esophageal tumors with different histological stratification and quantitative analysis of esophageal carcinoma has a high sensitivity to determine pipe wall invasion depth, specificity and accuracy. In the third part, 3 T high resolution MR imaging of esophageal cancer preoperative staging and pathological control study objective: To explore the 3 T high resolution MR imaging in the preoperative staging of esophageal cancer diagnosis. Materials and methods: a prospective continuously included by endoscopic biopsy confirmed that parallel imaging 3 T MR, 135 patients with esophageal cancer and surgical cases. By three radiologist in MRI stage, when In disagreements consensus through consultation; a pathological diagnosis of pathological staging. The thickness of physician.Kappa consistency test for simultaneous measurement of tumor maximum diameter of lesions for evaluation of MRI staging and pathological staging and three diagnostic imaging physician staging between consistent with pathological results as the gold standard to calculate the sensitivity, MRI staging of esophageal cancer the specificity and accuracy of.Bland-Altman plot for comparison between the three diagnostic imaging physician and their pathological diagnosis respectively and between physicians to measure the mass thickness consistency. Results: 109 cases of MRI patients with esophageal carcinoma and pathological staging (80.7%, 109/135), with good consistency (Kappa value =0.753) specific for.MRI the sensitivity of the diagnosis of stage T1a esophageal cancer, the accuracy is 57.1%, respectively, 98.3%, 94.1% (T1b; on stage were 73.9%, 94.6%, 91.1%; the T2 phase were 76.9%, 93.6%, 90.4%; the T3 phase were 78.4%, 95.9 %, 91.1%; for T4a stage were 100%, 95%, 96.3%.Bland-Altman scatterdiagram shows that three diagnostic imaging physician and pathology physicians between the thickness difference between the average were 2 mm, 2.6 mm and 2.1 mm; three radiologist between average thickness difference were 0.6 mm, 0.1 mm and 0.4 mm; diagnostic imaging physician and pathology physicians and each radiologist consistency between the measurement of mass thickness. Conclusion: 3.0T MR high resolution imaging can judge the esophageal wall infiltration depth, has great value in the staging of esophageal cancer preoperative accurate.

【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R445.2;R735.1
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本文編號：1600948