CAJ | 학술논문

目的：评价超高场强磁共振成像（ MRI）和多层螺旋CT（ MDCT）扫描在非小细胞肺癌（ NSCLC）术前T分期中的应用价值。方法2009年2月至2011年7月间经支气管镜检证实的40例NSCLC患者，术前均行MRI平扫、MRI增强及MDCT增强扫描，由3名高年资胸部放射诊断医师采用双盲法阅片，对NSCLC的术前T分期进行初步评估，并与术后病理结果进行对照，比较3种不同影像学方法对NSCLC原发肿瘤T分期的准确性。结果以手术病理分期为金标准，40例NSCLC患者中， MDCT增强扫描对原发肿瘤T分期评估准确者32例（Kappa值为0．621）；评估不准确者8例，其中高估1例，低估7例。 MRI平扫对原发肿瘤T分期评估准确者34例（Kappa值为0．718）；评估不准确者6例，其中高估2例，低估4例。 MRI增强对原发肿瘤T分期评估准确者35例（ Kappa值为0．757）；评估不准确者5例，其中高估3例，低估2例。 MDCT增强、MRI平扫和MRI增强对NSCLC术前T分期诊断的准确率分别为80．0％（32／40）、85．0％（34／40）和87．5％（35／40），其中MDCT增强与MRI平扫、MDCT增强与MRI增强、MRI平扫与MRI增强对NSCLC术前T分期诊断的准确率差异均无统计学意义（均P＞0．05）。结论 MRI平扫和增强对NSCLC术前T分期诊断的准确率高于MDCT增强，对于不能行增强CT扫描患者，超高场强MRI可作为评价NSCLC术前T分期的替代检查。
목적：평개초고장강자공진성상（ MRI）화다층라선CT（ MDCT）소묘재비소세포폐암（ NSCLC）술전T분기중적응용개치。방법2009년2월지2011년7월간경지기관경검증실적40례NSCLC환자，술전균행MRI평소、MRI증강급MDCT증강소묘，유3명고년자흉부방사진단의사채용쌍맹법열편，대NSCLC적술전T분기진행초보평고，병여술후병리결과진행대조，비교3충불동영상학방법대NSCLC원발종류T분기적준학성。결과이수술병리분기위금표준，40례NSCLC환자중， MDCT증강소묘대원발종류T분기평고준학자32례（Kappa치위0．621）；평고불준학자8례，기중고고1례，저고7례。 MRI평소대원발종류T분기평고준학자34례（Kappa치위0．718）；평고불준학자6례，기중고고2례，저고4례。 MRI증강대원발종류T분기평고준학자35례（ Kappa치위0．757）；평고불준학자5례，기중고고3례，저고2례。 MDCT증강、MRI평소화MRI증강대NSCLC술전T분기진단적준학솔분별위80．0％（32／40）、85．0％（34／40）화87．5％（35／40），기중MDCT증강여MRI평소、MDCT증강여MRI증강、MRI평소여MRI증강대NSCLC술전T분기진단적준학솔차이균무통계학의의（균P＞0．05）。결론 MRI평소화증강대NSCLC술전T분기진단적준학솔고우MDCT증강，대우불능행증강CT소묘환자，초고장강MRI가작위평개NSCLC술전T분기적체대검사。
Objective To compare the diagnostic efficacies of 64?MDCT and 3. 0?T MRI in determining the T stage of non?small cell lung cancer ( NSCLC) . Methods Approval from the institutional ethics committee and informed consent from patients were obtained before the study started. 40 patients with NSCLC proved by pathology were enrolled in the study. All the 40 patients underwent non?enhanced MRI, enhanced MRI, and enhanced MDCT. Their T stages were preliminarily evaluated according to these imaging manifestations by 3 groups of experienced chest radiologists respectively, and correlated with that of postoperative pathology using the Kappa test. The diagnostic efficacies of these three imaging modalities for determining the T stage of NSCLC were compared using the McNemar test. Results The preoperative diagnostic accuracy rate for the T stage of NSCLC was 85.0% (34 of 40) by non?enhanced MRI, 87.5% (35 of 40) by enhanced MRI, and 80. 0% ( 32 of 40 ) by enhanced CT, showing no significant differences between the non?enhanced MRI and enhanced CT, enhanced MRI and enhanced CT, and non?enhanced MRI and enhanced MRI for determining the T stage of NSCLC (P>0.05). Conclusions Compared with the enhanced MDCT, non?enhanced MRI and enhanced MRI provide slightly superior diagnostic efficacy for the preoperative T staging of NSCLC. For the patients with intolerance to contrast medium on MDCT scan, 3.0T MRI may be an alternative for determining the preoperative T stage of NSCLC.