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[目的]比较磁共振(MRI)和多层螺旋CT(MSCT)在胃癌术前诊断及分期上的临床应用价值。[方法]回顾性分析2008年1月～2013年2月于浙江大学附属第一医院及我院行病理活检证实的83例胃癌患者,对比分析MRI和MSCT对胃癌术前TNM分期与病理结果。[结果]83例患者中行常规MRI平扫者32例,其中显示多层结构者22例,显示率为68.75%;51例行动态增强MRI扫描,其中显示多层结构者45例,显示率为88.24%。MRI对胃癌总的T期及T1、T2、T3、T4分期的准确率分别为90.36%、85.00%、89.47%、91.67%、95.00%,MSCT对胃癌总的T期及T1、T2、T3、T4分期的准确率分别为77.11%、62.50%、73.68%、77.78%、85.00%,其中胃癌患者T分期MRI与MSCT检查结果对比显示T1、T2、T3、T4分期的准确率差异无统计学意义(P>0.05),而MRI总的T分期准确率明显高于MSCT,差异具有统计学意义(P<0.05)。MRI对术前胃癌N分期判断的敏感性、特异性和准确性分别为62.68%、68.75%和63.86%;MSCT对术前胃癌N分期判断的敏感性、特异性和准确性分别为80.60%、75%和79.52%。MRI与MSCT在N2期及总的N分期准确率上差异有统计学意义(P<0.05),在N0和N1期准确率比较差异无统计学意义(P>0.05)。MRI和MSCT对胃癌M分期判断的准确率均为95.83%。[结论]MRI和MSCT对于胃癌的术前TNM分期诊断各有优缺点,MRI对于T分期的准确率明显高于MSCT,而MSCT对于N分期淋巴结的显示有一定优势。
[Objective] To compare the clinical value of magnetic resonance imaging (MRI) and multi-slice spiral CT (MSCT) in preoperative diagnosis and staging of gastric cancer. [Methods] A retrospective analysis of 83 gastric cancer patients confirmed by pathological biopsy from the First Affiliated Hospital of Zhejiang University and our hospital from January 2008 to February 2013 was performed. The preoperative TNM staging and pathological results of gastric cancer were analyzed by MRI and MSCT. [Result] Among the 83 patients, 32 cases were routinely screened by MRI, among them, 22 cases showed multi-layer structures with a display rate of 68.75%. 51 cases had dynamic enhanced MRI scans, of which 45 cases showed multi-layer structure with a rate of 88.24%. The accuracy of MRI for the total T stage, T1, T2, T3 and T4 staging of gastric cancer were 90.36%, 85.00%, 89.47%, 91.67% and 95.00% respectively. The accuracy of T4 staging was 77.11%, 62.50%, 73.68%, 77.78% and 85.00%, respectively. The comparison of T stage MRI and MSCT showed that there was no significant difference in the accuracy of T1, T2, T3 and T4 staging (P> 0.05). The accuracy of MRI in T staging was significantly higher than that in MSCT (P <0.05). The sensitivity, specificity and accuracy of MRI for preoperative gastric cancer were 62.68%, 68.75% and 63.86%, respectively. The sensitivity, specificity and accuracy of MSCT for preoperative gastric cancer were 80.60% 75% and 79.52%. The accuracy of MRI and MSCT in N2 stage and total N stage was statistically significant (P <0.05), while there was no significant difference in accuracy between N0 and N1 stage (P> 0.05). MRI and MSCT staging accuracy of gastric cancer M were 95.83%. [Conclusion] MRI and MSCT have both advantages and disadvantages for preoperative TNM staging of gastric cancer. The accuracy of MRI for T staging is significantly higher than that of MSCT. MSCT has some advantages for the display of N staging lymph nodes.