食管癌的主动脉和气管支气管侵犯：3.0-T MRI 和 CT 的诊断性能比较。
Aorta and tracheobronchial invasion in esophageal cancer: comparing diagnostic performance of 3.0-T MRI and CT.
机构信息
Department of Radiology, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, No. 127 Dongming Road, Zhengzhou, 450008, Henan, China.
Department of Thoracic Surgery, Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, 450008, Henan, China.
出版信息
Eur Radiol. 2023 Jul;33(7):4962-4972. doi: 10.1007/s00330-023-09425-2. Epub 2023 Jan 24.
OBJECTIVES
To compare between the diagnostic performance of 3.0-T MRI and CT for aorta and tracheobronchial invasion in patients with esophageal cancer (EC).
METHODS
We prospectively included patients with pathologically confirmed EC from November 2018 to June 2021, who had baseline stage of T3-4N0-2M0 and restaging after neoadjuvant chemotherapy. All patients underwent contrast-enhanced CT and MRI of the thorax. Two independent blinded radiologists scored image quality and the presence of invasion. Agreements between the two readers were calculated using kappa test. The sensitivity, specificity, accuracy, positive predict value (PPV), and negative predict value (NPV) of MRI and CT in evaluating invasion were calculated. The net reclassification index (NRI) was used to evaluate the change in the number of patients correctly classified by MRI and CT.
RESULTS
A total of 70 patients (64.8 ± 9.0 years; 53 men) were enrolled. Inter-reader agreements of image quality scores and presence of invasion by MRI and CT between the two readers were almost perfect (kappa > 0.80). The accuracy of MRI in evaluating thoracic aorta invasion was significantly higher than that of CT (reader 1: 90.0% vs. 71.4%; reader 2: 92.9% vs. 70.0%, respectively), and the accuracy of MRI in evaluating tracheobronchial invasion also was significantly higher than that of CT (reader 1: 92.9% vs. 72.9%; reader 2: 95.7% vs. 70.0%, respectively). NRI values were positive in both the evaluation of aorta and tracheobronchial invasion.
CONCLUSIONS
The accuracy of 3-T MRI in determining thoracic aorta and tracheobronchial invasion is significantly higher than that of CT.
KEY POINTS
• 3.0-T MRI was significantly more accurate than CT in assessing invasion of the thoracic aorta in patients with esophageal cancer. • 3.0-T MRI was also significantly more accurate than CT in assessing tracheobronchial invasion in patients with esophageal cancer. • 3.0-T MRI has a higher diagnostic performance than CT in evaluating patients with suspected aortic or tracheobronchial invasion in esophageal cancer.
目的
比较 3.0-T MRI 和 CT 对食管癌患者主动脉和气管支气管侵犯的诊断性能。
方法
我们前瞻性纳入了 2018 年 11 月至 2021 年 6 月期间经病理证实的食管癌患者，这些患者的基线分期为 T3-4N0-2M0，并在新辅助化疗后进行了重新分期。所有患者均接受了胸部增强 CT 和 MRI 检查。两位独立的盲法阅片医生对图像质量和侵犯情况进行评分。使用 Kappa 检验计算两位读者之间的一致性。计算 MRI 和 CT 评估侵犯的灵敏度、特异度、准确性、阳性预测值（PPV）和阴性预测值（NPV）。使用净重新分类指数（NRI）评估 MRI 和 CT 对患者分类数量的改变。
结果
共纳入 70 例患者（64.8±9.0 岁；53 名男性）。MRI 和 CT 的图像质量评分和侵犯存在的两位读者之间的读者间一致性几乎为完美（kappa＞0.80）。MRI 评估胸主动脉侵犯的准确性明显高于 CT（读者 1：90.0%比 71.4%；读者 2：92.9%比 70.0%），MRI 评估气管支气管侵犯的准确性也明显高于 CT（读者 1：92.9%比 72.9%；读者 2：95.7%比 70.0%）。在主动脉和气管支气管侵犯的评估中，NRI 值均为正值。
结论
3.0-T MRI 对确定胸主动脉和气管支气管侵犯的准确性明显高于 CT。
关键要点
3.0-T MRI 在评估食管癌患者的胸主动脉侵犯方面明显比 CT 更准确。
3.0-T MRI 在评估食管癌患者的气管支气管侵犯方面也明显比 CT 更准确。
3.0-T MRI 在评估疑似主动脉或气管支气管侵犯的食管癌患者方面具有比 CT 更高的诊断性能。
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