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磁共振成像联合弥 散加权成像对腹膜 转移癌的诊断价值*

作者:隋海晶1 闫成功2 赵振国1 谢秀海1

所属单位:1.上海市浦东新区人民医院放射科 (上海 201299) 2.上海市浦东新区中医医院放射科 (上海 201299)

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摘要

目的 探讨磁共振成像(MRI)联合 弥散加权成像(DWI)对腹膜转移癌的诊断 价值。方法 由两名高级职称影像医生在 不知病理学结果的情况下分析我院2014 年1月-2015年12月期间接收诊治的45例 经手术病理证实的腹膜转移癌患者的常规 MRI扫描和常规MRI联合DWI影像学资料, 判断患者是否为腹膜转移癌,对膈下、道 格拉斯窝、右结肠旁沟、左结肠旁沟、网 膜及系膜进行重点观察,进一步比较常规 MRI扫描和常规MRI联合DWI扫描对腹膜癌 转移癌的诊断灵敏度、特异度及符合率。 结果 常规MRI、常规MRI联合DWI图像对腹 膜转移瘤的诊断灵敏度和特异度分别为 69.70%与71.43%、96.77%与78.57%。常规 MRI对腹膜转移癌的诊断符合率(73.33%) 明显低于常规MRI联合DWI对腹膜转移癌的 诊断符合率(91.11%),差异具有统计学 (χ2 =4.865,P<0.05)。结论 常规MRI结 合DWI可以有效提高腹膜转移的诊断准确 率,降低假阳性率,值得在临床推广应 用。

Objective To investigate the diagnostic value of MRI combined with DWI in treating peritoneal metastatic carcinoma. Methods 45 cases with peritoneal metastatic carcinoma in our hospital from January 2014 to December were selected and analyzed by two radiologists with senior professional post. They were given MRI and MRI combined with DWI treatment in order to judge whether or not had peritoneal metastatic carcinoma. Diaphragm, douglas pouch, right paracolic sulci, left paracolic sulci, omentum and mesentery were emphatically observed. Compare the sensitivity, specificity and coincidence rate of MRI and MRI combined with DWI treatment. Results Sensitivity and specificity of MRI, MRI combined with DWI were 69.70% and 71.43%, 96.77% and 78.57%. Coincidence rate of MRI group (73.33%) was obviously lower than MRI combined with DWI group (91.11%), the difference was statistically significant (χ2 =4.865, P<0.05). Conclusion MRI combined with DWI in treating peritoneal metastatic carcinoma can improve diagnosis accuracy of peritoneal metastatic carcinoma, lower false positive rate and is worthy of wide application.

【关键词】磁共振成像;联合;弥散加权 成像;腹膜转移癌

【中图分类号】R322.4+92

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2016.10.034

前言

腹膜转移癌(peritoneal carcinomatosis, PC),多继发于胃癌、 结肠癌、卵巢癌、胰腺癌等腹部恶性肿瘤,是恶性肿瘤在腹膜腔内的 转移播散,目前的常规治疗效果有限,中位生存期不足6个月[1-2]。PC 正确的早期诊断和原发肿瘤的术前分期密切相关,了解恶性病变腹膜 转移及侵及的范围和程度,是临床治疗策略的选择及评估预后的重 要依据,选择合理手术方式的患者可缩短术中探查和麻醉时间,同 时降低术后相关并发症,延长患者生存时间[3]。因此,早期准确的诊 断出PC就显得至关重要。磁共振弥散加权成像(diffusion-weighted imaging;DWI)是近年来发展起来的磁共振检查的新技术,是目前唯 一能够无创性的反应分子扩散特征的成像方法。DWI与MRI扫描技术联 合应用,可在短时间内获得全身弥散图像,之后通过3D-MIP重建和黑 白反转技术,可将恶性肿瘤原发灶和转移灶以三维图像形式呈现出 来[4]。本研究旨在探讨常规MRI及联合DWI对腹膜转移瘤诊断敏感性与 特异性,并比较其对腹腔转移灶的检测能力。