本文選題：胃癌 + MRI　； 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：[目的]探討MRI在胃癌術(shù)前分期中的應(yīng)用價(jià)值。[方法]收集昆明醫(yī)科大學(xué)第一附屬醫(yī)院腫瘤科2015年6月至2016年12月手術(shù)治療的胃癌患者28例,所有患者術(shù)前行腹盆腔MRI檢查,根據(jù)MRI圖像進(jìn)行術(shù)前分期,并與術(shù)后病理結(jié)果進(jìn)行對(duì)照。[結(jié)果]1、28例患者中,MRI對(duì)胃癌術(shù)前T分期判定結(jié)果如下:T1期為1例,T2期為7例,T3期為11例,T4期為9例。病理診斷下T分期判定結(jié)果如下:T1期為3例,T2期為3例,T3期為12例,T4期為10例。MRI與術(shù)后病理診斷相比:T1期的靈敏度為33.3%,特異度為100%,準(zhǔn)確率為92.9%,T2期的靈敏度為66.7%,特異度為80%,準(zhǔn)確率為78.6%,T3期的靈敏度為66.7%,特異度為81.2%,準(zhǔn)確率為75%,T4期的靈敏度為80%,特異度為94.4%,準(zhǔn)確率為89.3%。MRI對(duì)胃癌術(shù)前N分期判定結(jié)果如下:N0期為10例,N1期為5例,N2期為8例,N3期為5例。病理診斷下N分期判定結(jié)果如下:NO期為9例,N1期為4例,N2期為5例,N3期為10例。MRI與術(shù)后病理診斷相比:NO期的靈敏度為77.8%,特異度為84.2%,準(zhǔn)確率為82.1%,N1期的靈敏度為25%,特異度為83.3%,準(zhǔn)確率為75%,N2期的靈敏度為60%,特異度為78.3%,準(zhǔn)確率為75%,N3期的靈敏度為50%,特異度為100%,準(zhǔn)確率為82.1%。2、28例患者中腫瘤位于胃底1例,胃體9例,胃竇18例,胃體中T分期的準(zhǔn)確率分別為 T1(100%)、T2(77.8%)、T3(77.8%)、T4(100%,P0.01),N 分期的準(zhǔn)確率分別為 NO(77.8%)、N1(88.9%)、N2(66.7%)、N3(88.9%,P0.01);胃竇中T分期的準(zhǔn)確率分別為T1(88.9%,P0.01)、T2(77.8%)、T3(77.8%,P0.01)、T4(88.9%,P0.01),N 分期的準(zhǔn)確率分別為NO(83.3%,P0.01)、N1(66.7%)、N2(72.2%)、N3(77.8%)。3、28例患者中腫瘤位于胃小彎20例,胃大彎7例。胃小彎中T分期的準(zhǔn)確率分別為 T1(90%,P0.01)、T2(85%,P0.01)、T3(85%,P0.01)、T4(90%,P0.01),N 分期的準(zhǔn)確率分別為 NO(90%,P0.01)、N1(75%)、N2(75%)、N3(80%,P0.01),胃大彎中T分期的準(zhǔn)確率分別為T1(100%)、T2(57.1%)、T3(57.1%)、T4(100%,P0.01),N 分期的準(zhǔn)確率分別為NO(57.1%)、N1(71.4%)、N2(71.4%)、N3(85.7%,P0.01)。4、28 例患者中 Borrmann Ⅰ 型 0 例,Borrmann Ⅱ 型 11 例,Borrmann Ⅲ 型 8例,Borrmann Ⅳ型9例。Borrmann Ⅱ型中T分期的準(zhǔn)確率分別為T1(90.9%)、T2(81.8%,P0.01)、T3(81.8%,P0.01)、T4(90.9%,P0.01),N 分期的準(zhǔn)確率分別為 NO(81.8%)、N1(63.6%)、N2(54.5%)、N3(72.7%);Borrmann Ⅲ型中 T 分期的準(zhǔn)確率分別為 T1(87.5%,P0.01)、T2(75%)、T3(75%,P0.01)、T4(87.5%,P0.01),N 分期的準(zhǔn)確率分別為 NO(87.5%,P0.01)、N1(75%)、N2(100%)、N3(87.5%,P0.01);Borrmann Ⅳ型中 T 分期的準(zhǔn)確率分別為 T1(100%)、T2(77.8%)、T3(66.7%)、T4(88.9%,P0.01),N 分期的準(zhǔn)確率分別為 NO(77.8%,P0.01)、N1(88.9%,P0.01)、N2(77.8%)、N3(88.9%,P0.01)。5、28例患者中Lauren分型為腸型2例,混合型9例,彌漫型9例(有8例患者病檢報(bào)告未診斷),Lauren分型為混合型的T分期的準(zhǔn)確率分別為T1(88.9%)、T2(77.8%)、T3(77.8%,P0.01)、T4(88.9%,P0.01),N分期的準(zhǔn)確率分別為NO(77.8%,P0.01)、N1(44.4%)、N2(66.7%)、N3(77.8%),Lauren分型為彌漫型的T分期的準(zhǔn)確率分別為T1(100%)、T2(88.9%)、T3(77.8%,P0.01)、T4(88.9%,P0.01),N 分期的準(zhǔn)確率分別為N0(88.9%,P0.01)、N1(100%,P0.01)、N2(77.8%)、N3(88.9%,P0.01)。[結(jié)論]1、MRI對(duì)胃癌術(shù)前分期有較高的準(zhǔn)確率,特別在T3、T4和N3分期上更具有明顯優(yōu)勢(shì);2、MRI對(duì)胃小彎腫瘤在T及N分期中有較高的準(zhǔn)確率,與術(shù)后病檢一致性較高。3、在不同的Borrmann分型中,T分期中T4有較高的準(zhǔn)確率,N分期中N3準(zhǔn)確率較高,且隨分型而增高,與術(shù)后病檢一致性較高。4、Lauren分型為彌漫型腫瘤有較高的T、N分期,特別在N分期上有優(yōu)勢(shì)。
[Abstract]:[Objective] to investigate the value of MRI in the preoperative staging of gastric cancer. [Methods] 28 cases of gastric cancer were collected from the oncology department of the First Affiliated Hospital of Kunming Medical University from June 2015 to December 2016. All patients underwent abdominal pelvic MRI examination before operation, and the preoperative staging was carried out according to MRI images and compared with the postoperative pathological results. [results]1,28 In the patients with MRI, the results were as follows: the T1 stage was 1, T2 was 7, T3 was 11, and T4 was 9. The pathological diagnosis of T staging was as follows: T1 phase was 3, T2 was 3, T3 was 12,.MRI was 33.3%, specificity was 100%, and the accuracy was 92.9%. The sensitivity was 66.7%, the specificity was 80%, the accuracy was 78.6%, the sensitivity of the T3 stage was 66.7%, the specificity was 81.2%, the accuracy was 75%, the sensitivity of the T4 stage was 80%, the specificity was 94.4%, and the accuracy was 89.3%.MRI for the preoperative N staging of gastric cancer as follows: the N0 stage was 10, the N1 period was 5, the N2 phase was 8, the N3 phase was 5. The pathological diagnosis of N staging. The results were as follows: phase NO was 9, stage N1 was 4, N2 phase was 5, N3 period was 10 cases of.MRI compared with postoperative pathological diagnosis: the sensitivity of NO stage was 77.8%, specificity was 84.2%, accuracy was 82.1%, sensitivity of N1 phase was 25%, specificity was 83.3%, accuracy was 75%, N2 sensitivity was 60%, specificity was 78.3%, accuracy rate was 75%, N3 period sensitivity. For 50%, the specificity was 100%, the accuracy rate was 1 cases in the fundus of the stomach in 82.1%.2,28 cases, 9 cases in the stomach body, 18 cases in the gastric antrum, and the accuracy rate of T staging in the stomach body was T1 (100%), T2 (77.8%), T3 (77.8%), T4 (100%, P0.01), the accuracy rate of N staging was respectively NO (77.8%), N1 (88.9%), N2 (66.7%), N3 (88.9%,), respectively. The accuracy rate in the gastric antrum was respectively the rate of the staging of the gastric antrum. T1 (88.9%, P0.01), T2 (77.8%), T3 (77.8%, P0.01), T4 (88.9%, P0.01). The accuracy of N staging is NO (83.3%, P0.01), N1 (66.7%), N2 (72.2%), 77.8%) in 20 cases of gastric small bend and 7 cases in stomach bend. The accuracy rate was NO (90%, P0.01), N1 (75%), N2 (75%), N3 (80%, P0.01), the accuracy rate of T staging in the big stomach curve was T1 (100%), T2 (57.1%), T3 (57.1%), T4 (100%, P0.01), respectively (57.1%), 71.4%, 71.4%, 85.7%. The accuracy rate of T staging in type Borrmann IV type 9 cases (type Borrmann IV) was T1 (90.9%), T2 (81.8%, P0.01), T3 (81.8%, P0.01), T4 (90.9%, P0.01), T4 (81.8%), 63.6%, 72.7%, 72.7%, 72.7%, 87.5%, 72.7%, respectively. P0.01), the accuracy of N staging was NO (87.5%, P0.01), N1 (75%), N2 (100%), N3 (87.5%, P0.01). The accuracy of T staging in Borrmann IV was T1 (100%), T2 (66.7%), 88.9%, 77.8%, 88.9%, respectively. 2 cases of intestinal type, 9 cases of mixed type and 9 cases of diffuse type (8 cases undiagnosed by disease examination), the accuracy rate of Lauren classification as mixed type T staging is T1 (88.9%), T2 (77.8%), T3 (77.8%, P0.01), T4 (88.9%, P0.01), N staging, respectively, NO (77.8%, 44.4%), N1 (66.7%), 77.8%). The accuracy rates were T1 (100%), T2 (88.9%), T3 (77.8%, P0.01), T4 (88.9%, P0.01), and the accuracy of N staging was N0 (88.9%, P0.01), N1 (100%, P0.01), N2 (77.8%), and 88.9%. There was a high accuracy rate and high consistency with postoperative disease detection. In the different Borrmann typing, T4 had higher accuracy in T staging. The accuracy rate of N3 in N staging was higher, and with the classification, the consistency was higher in.4, Lauren typing for diffuse tumors had higher T, N staging, especially in N stage.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R735.2

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