摘要目的 探讨食管鳞癌动态对比增强MRI(DCE-MRI)定量参数与病理分级间的相关性.方法 前瞻性分析经电子消化道内镜证实的食管鳞癌,行食管癌根治术获得病理结果,且术前1周内行MRI检查的39例患者的临床和影像资料.患者均行胸部常规MRI和DCE-MRI扫描,测量DCE-MRI定量参数,包括容积转移常数(Ktrans)、速率常数(Kep)及血管外细胞外间隙容积比(Ve).对手术后标本进行病理分析,包括病理分级(高分化、中分化、低分化、未分化)、肿瘤病理大体类型(溃疡型、髓质型、蕈伞型、硬化型)和肿瘤局部浸润程度(T分期)分析.采用Kruskal-Wallis H检验比较不同病理T分期、肿瘤病理大体类型、病理分级间DCE-MRI各定量参数的差异,采用Spearman秩相关分析评价DCE-MRI各参数值与食管鳞癌病理分级的相关性,采用ROC评价各参数诊断低分化食管鳞癌的效能.结果 高分化鳞癌12例、中分化15例、低分化12例;溃疡型鳞癌19例、蕈伞型10例、髓质型10例;T1、2期16例,T3期14例,T4期9例.不同T分期组间和不同肿瘤大体类型组间的Ktrans、Kep及Ve值差异均无统计学意义(P均>0.05).不同病理分级组间的Ktrans、Kep及Ve值差异有统计学意义(P均<0.05),Ktrans、Kep及Ve值与组织病理分级均呈正相关,r值分别是0.874、0.672、0.578,P均<0.01.Ktrans、Kep及Ve值诊断低级别食管鳞癌的ROC下面积分别为0.941、0.809和0.773,其中Ktrans的诊断效能最佳.结论 DCE-MRI定量参数与食管鳞癌的病理分级具有相关性,Ktrans、Kep及Ve值均可在一定程度上反映不同病理分级的食管鳞癌的血流灌注特征.

abstractsObjective To investigate the correlation between dynamic contrast enhancement magnetic resonance imaging (DCE-MRI) quantitative parameters and pathological grading in esophageal squamous cell carcinoma(SCC). Methods Prospective analysis of esophageal squamous cell carcinoma confirmed by electronic gastrointestinal endoscopy was performed. Thirty nine patients who underwent radical resection of esophageal carcinoma with MRI examination one weeks before operation were included. All patients underwent routine chest MRI and DCE-MRI scans, and DCE-MRI quantitative parameters including volume transfer constant (Ktrans), exchange rate constant (Kep) and extravascular extracellular volume fraction(Ve)were measured.Pathological analysis of postoperative specimens,including pathological grading(highly differentiated,moderately differentiated,poorly differentiated,undifferentiated),gross tumor pathological type(ulcerative type,medullary type,fungating type,sclerotic type)and local infiltration degree (T staging) were performed. Kruskal-Wallis H test was used to compare the differences of quantitative parameters between different pathological T staging,gross tumor pathological types and pathological grades of DCE-MRI,and a Dunn-Bonferroni test for post hoc comparisons.Spearman rank correlation analysis was used to evaluate the correlation between DCE-MRI parameters and pathological grading of esophageal squamous cell carcinoma.The ROC curves was used to evaluate the efficiency of different parameters in the diagnosis of poorly differentiated esophageal squamous cell carcinoma. Result Among the thirty nine patients, they were divided into three group according to pathological findings: well differentiated (12 patients),moderately differentiated(15 patients)and poorly differentiated group(12 patients);ulcerative type (19 patients), fungating type(10 patients), medullary type(10 patients);T1, 2 stage(16 patients), T3 stage(14 patients), and T4 stage(9 patients). There was no significant difference in the value of Ktrans, Kepand Ve between different T staging groups and different tumor pathological types groups(all P>0.05).The differences of Ktrans, Kepand Vebetween different pathological grading groups were statistically significant (all P<0.05). There were positive correlation between Ktrans, Kep, Veand the pathological grading, rs value were 0.874, 0.672, 0.578 respectively, all P<0.01. The ROC curve area of Ktrans, Kepand Vein the diagnosis of poorly differentiated esophageal squamous cell carcinoma was 0.941,0.809 and 0.773 respectively.The diagnostic efficiency of Ktranswas the best.Conclusions The quantitative parameters of DCE-MRI are correlated with the pathological grading of esophageal squamous cell carcinoma. Ktrans, Kepand Vecan reflect the perfusion characteristics of esophageal squamous cell carcinoma.