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目的:探讨磁共振成像对肺癌淋巴结转移的诊断价值。材料及方法:将55例肺癌病人术前MRI显示淋巴结的情况与术后比较,以直径在1cm及1.5cm为阈值计算其敏感性、特异性、准确性、阳性预测值及阴性预测值;应用DIASONICS0.35T超导成像系统行T1及T2加权成像。结果:87.3％(48例)的病人MRI可见肺门及纵隔淋巴结肿大,共133个,其中119个信号在T1WI及T2WI上与肿瘤相似,占89.5％;另14个比肿瘤信号略低,占10.5％。手术摘除淋巴结150个,MRI漏计17个,占11.3％。150个淋巴结中44例(80％)74个(49.3％)有转移。1cm以下的淋巴结转移率为5.9％(2/34),1cm～1.5cm的淋巴结转移率为42.3％(30/71),1.5cm以上的转移率为93.3％(42/45)。按1cm及1.5cm以上为阈值,其敏感性、特异性、准确性、阳性预测值及阴性预测值分别为97.3％、52.6％、74.6％、66.7％、95.2％及56.8％、96.1％、76.7％、93.3％、69.5％。结论:MRI显示淋巴结虽有许多优点,但判断淋巴结有无转移仍只能以大小作为标准,信号强度帮助不大;作者认为MRI可采用与CT相似的标准,即将1cm—1.5cm的淋巴结列为可疑,1.5cm以上的定为转移;是否增强以后信号强度对鉴别诊断有所帮助有待于进一步研究。
Objective: To investigate the diagnostic value of magnetic resonance imaging in lymph node metastasis of lung cancer. Materials and Methods: The sensitivity, specificity, accuracy, positive predictive value, and negative predictive value of MRI showed lymph nodes before surgery in 55 patients with lung cancer. DIASONICS 0.35T superconducting imaging system for T1 and T2 weighted imaging. RESULTS: MRI showed hilar and mediastinal lymph node enlargement in 87.3% (48 patients), of which 133 were similar to the tumor on T1WI and T2WI, accounting for 89.5%; the other 14 were slightly lower than the tumor signal. It accounts for 10.5%. 150 lymph nodes were removed surgically and 17 MRI leaks accounted for 11.3%. Of the 150 lymph nodes, 44 (80%) had 74 (49.3%) metastases. The lymph node metastasis rate below 1 cm was 5.9% (2/34), the lymph node metastasis rate was 42.3% (30/71) at 1cm to 1.5cm, and the metastatic rate was 93.3% (42/45) at 1.5cm or above. According to the threshold values above 1cm and 1.5cm, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value were 97.3%, 52.6%, 74.6%, 66.7%, 95.2% and 56.8%, 96.1%, 76.7, respectively. %, 93.3%, 69.5%. Conclusion: Although MRI shows many advantages of lymph nodes, the size of the lymph nodes can only be used as a criterion to judge whether there is metastasis or not. The signal intensity does not help much. The authors believe that MRI can use a standard similar to that of CT, that is, 1 cm to 1.5 cm of lymph nodes are listed as Suspected, more than 1.5cm as the transfer; whether to strengthen the signal strength after the differential diagnosis help to be further studied.