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临床研究
MRI联合序列对比MDCT在食管鳞癌T分期诊断效能的研究
林生发 苏丽清 彭英 沈衍富 李添 马明平

Cite this article as: Lin SF, Su LQ, Peng Y, et al. Study on the diagnostic efficacy of combined MRI sequences contrast MDCT in T staging of esophageal squamous cell carcinoma[J]. Chin J Magn Reson Imaging, 2022, 13(4): 43-48.本文引用格式:林生发, 苏丽清, 彭英, 等. MRI联合序列对比MDCT在食管鳞癌T分期诊断效能的研究[J]. 磁共振成像, 2022, 13(4): 43-48. DOI:10.12015/issn.1674-8034.2022.04.008.


[摘要] 目的 通过对比食管鳞癌MRI联合序列与多排螺旋计算机体层摄影 (multi detector-row computed tomography,MDCT)的T分期诊断效能,为临床精准T分期提供参考依据。材料与方法 前瞻性纳入90例福建省立医院活检证实为食管鳞癌的住院患者,皆有完整MRI联合序列(高分辨率T2-TSE-BLADE序列+高分辨率T1-STAR-VIBE-FS延迟增强序列)、MDCT增强检查数据。由两名影像科主治医师在双盲下分别进行评估,采用Kappa检验评估两名阅片者T分期一致性。参照术后病理金标准分别计算上述两种T分期方法的敏感度、特异度及约登指数;MRI联合序列、单模态序列、MDCT分期方法分别对照病理标准进行一致性Kappa分析。结果 术后病理T分期:T1期22例(24.44%)、T2期22例(24.44%)、T3期34例(37.78%)、T4a期12例(13.33%)。两名阅片者两种T分期方法一致性检验Kappa值分别为0.97、0.86。结果显示:(1) MRI联合序列对T1~T3期的敏感度、特异度及约登指数均高于MDCT;(2)两种分期方法对T4a期的敏感度较低,特异度高,约登指数较低;(3) MRI联合序列、单模态序列、MDCT分期方法与病理标准一致性分析Kappa值从高到低分别为MRI联合序列(0.91)、T1-STAR-VIBE-FS (0.81)、T2-TSE-BLADE (0.78)、MDCT (0.71)。结论 MRI联合序列对食管鳞癌T分期效能优于MDCT。
[Abstract] Objective To compare the diagnostic efficacy between combined MRI sequences and multi detector-row computed tomography (MDCT) in T staging of esophageal squamous cell carcinoma, so as to provide a reference basis for clinical accurate T staging.Materials and Methods Ninty patients with esophageal squamous cell carcinoma confirmed by biopsy in our hospital were prospectively collected. All of them had complete combined MRI sequences (high-resolution T2-TSE-BLADE sequence, high-resolution T1-STAR-VIBE-FS delayed enhancement sequence) and MDCT enhancement examination data. The evaluation was performed separately under double-blind by two attending radiologists, and the Kappa consistency test was used to evaluate the consistency of the T staging of the two subjects. The sensitivity, specificity and Yoden index of the above two T-staging methods were calculated according to the gold standard of postoperative pathology; the consistency of combined MRI sequences, single-mode sequence and MDCT staging were analyzed by Kappa consistency test according to the pathological criteria.Results Postoperative pathological T staging: 22 patients (24.44%) in T1 stage, 22 patients (24.44%) in T2 stage, 34 patients (37.78%) in T3 stage and 12 patients (13.33%) in T4a stage. The Kappa values of the consistency test of the two T staging methods for the two subjects were 0.97 and 0.86, respectively. The results of this study: (1) The sensitivity, specificity and Youden index of the combined MRI sequences for T1-T3 stages are higher than those of MDCT; (2) The two staging methods have low sensitivity, high specificity, and low Youden index for T4a; (3) The Kappa values from high to low were combined MRI sequences (0.91), T1-STAR-VIBE-FS (0.81), T2-TSE-BLADE (0.78) and MDCT (0.71).Conclusions Combined MRI sequences are better than MDCT for T staging of esophageal squamous cell carcinoma.
[关键词] 食管鳞癌;磁共振成像;多排螺旋计算机体层摄影;T分期;诊断效能
[Keywords] esophageal squamous cell carcinoma;magnetic resonance imaging;multi detector-row computed tomography;T staging;diagnostic efficacy

林生发 1   苏丽清 2   彭英 1   沈衍富 1   李添 1   马明平 1*  

1 福建医科大学省立临床医学院 福建省立医院放射科,福州 350001

2 福建医科大学肿瘤临床医学院 福建省肿瘤医院放诊科,福州 350011

马明平,E-mail:15859043670@163.com

作者利益冲突声明:全部作者均声明无利益冲突。


基金项目: 福建省自然科学基金项目 2018J01249
收稿日期:2022-01-04
接受日期:2022-03-21
中图分类号:R445.2  R735.1 
文献标识码:A
DOI: 10.12015/issn.1674-8034.2022.04.008
本文引用格式:林生发, 苏丽清, 彭英, 等. MRI联合序列对比MDCT在食管鳞癌T分期诊断效能的研究[J]. 磁共振成像, 2022, 13(4): 43-48. DOI:10.12015/issn.1674-8034.2022.04.008

       食管癌是世界上第六大癌症死亡原因,组织学上鳞癌约占90%[1];在我国的发生率、死亡率分别排在恶性肿瘤第六位、第四位[2]。治疗上T1~T2期食管癌单纯通过手术切除即可获取较长无进展生存期(progress free survival,PFS)[3],而未伴发淋巴结转移的T3~T4期食管癌患者接受术前新辅助治疗后也能较好延长PFS[4, 5],因此食管癌术前精准T分期是亟待解决的问题。然而,目前常用分期方法存在分期准确性较低,未能完全达到临床需求[6]。例如,食管镜能够观察肿瘤腔内情况并且活检,却无法观察肿瘤侵犯深度及管周情况;超声内镜对T分期具有一定价值,特异度较高而敏感度较低[7],受检查者主观因素影响大,且有15%~30%的患者因管腔狭窄内镜无法通过;食管钡餐也能观察管腔狭窄情况,却无法观察侵犯深度及管周情况[8];多排螺旋计算机体层摄影 (multi detector-row computed tomography,MDCT)对于观察食管癌侵犯深度及管周情况具有一定价值,但其对浅表黏膜病变不敏感而影响分期准确度[8]

       既往MRI软硬件水平受限,检查时间长且图像易受食管周围众多伪影干扰,因而限制了其临床价值。随着MRI技术提升,在不断提高软组织分辨率的同时,还能有效地克服食管伪影。因此,MRI成为临床研究T分期、可切除性评估及新辅助疗效评估的热点[9, 10, 11, 12, 13],多位学者采用刀锋伪影校正快速自旋回波T2加权成像(T2-turbo spin echo-BLADE,T2-TSE-BLADE)、高分辨星形容积内插屏气检查脂肪抑制(T1-STAR-volumetric interpolated breath-hold examination-fat suppression,T1-STAR-VIBE-FS)、精确频率反转恢复弥散加权成像(spectral presaturation attenuated inversion recovery-diffusion weighted imaging,SPAIR-DWI)、磁共振动态对比增强检查(dynamic contrast enhanced-MR,DCE-MR)、弥散加权成像-体素内不相干运动(diffusion weighted imaging-intra voxel incoherent motion,DWI-IVIM)、T2-mapping等单模态序列作为研究技术,其中T1-STAR-VIBE-FS序列对早期食管癌诊断效能高于晚期[14],T2-TSE-BLADE序列对晚期食管癌诊断效能高于早期[15]。本研究通过比较MRI联合序列(T2-TSE-BLADE+T1-STAR-VIBE-FS)与MDCT在食管鳞癌的T分期诊断效能,探讨MRI联合序列临床应用价值。

1 资料与方法

1.1 一般资料

       本研究为前瞻性研究,连续纳入福建省立医院2019年5月至2021年5月住院食管鳞癌患者112例,进行MRI联合序列对比MDCT在食管鳞癌T分期效能的研究。本研究经福建省立医院伦理委员会批准,批准文号:K2021-12-018,全体受试者均签署了知情同意书。

1.2 纳排标准

       纳入标准:(1)内镜活检结果为食管鳞癌;(2)食管MRI联合序列检查、MDCT检查数据完整;(3)临床相关资料完善。排除标准:(1)术前已接受化学治疗、免疫治疗或放射治疗等疗法;(2)影像质量未达到评估要求。

1.3 MRI及MDCT检查方法

       患者取仰卧位,以头足位进入扫描架,扫描范围自食管入口处至右肾门水平。扫描设备为3.0 T磁共振扫描仪(Prisma,西门子,德国),体部18通道相控阵线圈。对比剂为马根维显(Gd-DTPA,拜耳公司,德国),高压团注,注射总量0.1 mmol/kg,流率1.5 mL/s。MRI联合序列包括高分辨T2-TSE-BLADE序列与高分辨T1-STAR-VIBE-FS延迟增强序列,扫描时长分别约5 min、6 min,总体扫描成功率约97.3%,具体参数见表1。CT扫描仪为64排扫描仪(Sensation,西门子,德国),序列包括平扫、增强,对比剂为碘佛醇(江苏恒瑞医药,中国),高压团注,注射总量1.5 mL/kg,流率3.0 mL/s。

表1  MRI联合序列详细参数
Tab. 1  Detailed parameters of combined MRI sequences

1.4 病理学T分期标准及影像学T分期标准

1.4.1 病理学分期标准

       参照2017年国际抗癌联盟/美国癌症联合会(Union for International Cancer Control/American Joint Committee on Cancer,UICC/AJCC)第8版食管癌分期标准(表2)。

表2  第8版食管癌TNM分期
Tab. 2  TNM staging of esophageal cancer, 8th Edition

1.4.2 MDCT分期标准

       MDCT扫描T分期诊断标准[16],T1期:腔内肿块或轻度管壁增厚(≤5 mm);T2期:管壁增厚(5~10 mm),无外侵;T3期:管壁增厚(≥10 mm),无或累及管周脂肪间隙,但无侵犯邻近器官组织;T4期:管壁增厚伴外侵(T4a期:外侵至胸膜、心包、奇静脉、膈肌或腹膜;T4b期:外侵至主动脉、椎体或气管)。

1.4.3 MRI联合序列分期标准

       正常食管MRI征象:(1)高分辨T1-STAR-VIBE-FS延迟增强序列:黏膜层及黏膜下层(高信号)、固有肌层(稍低信号)、外膜(稍高信号)、管周脂肪间隙(低信号)[14];(2)高分辨T2-TSE-BLADE序列:黏膜层及黏膜下层(高信号)、固有肌层(低信号)、外膜(稍低信号),管周脂肪间隙(高信号)[15]

       MRI联合序列分期:参照2017年UICC/AJCC第8版食管癌分期标准,将食管癌厚度<10 mm的病例(即可能为T1~T2期患者)使用高分辨T1-STAR-VIBE-FS延迟增强序列进行T分期;食管癌厚度≥10 mm的病例(即可能为T3~T4a期患者)使用高分辨T2-TSE-BLADE序列进行T分期。

1.5 图像评估方法

       图像分析前,先排除图像不符合诊断标准病例及未手术病例。采用双盲法,由两名具有8年以上工作经验的影像科医师分别评估,对有不同意见病例经讨论协商一致。

1.6 统计学方法

       数据统计分析采用SPSS 25.0版软件。计数资料采用构成比及频数表示。使用Kappa检验评估两名阅片医师分期的一致性、评估两种分期方法与病理分期的一致性。最后分别计算出MRI联合序列、MDCT在T1~T4a分期中的敏感度、特异度及约登指数,多维度对照分析两种方法诊断效能。统计采用检验水准α=0.05,P<0.05认为差异有统计学意义。

1.7 食管鳞癌手术方式

       采用食管癌VATS根治术[17],即右进胸三切口全胸段食管切除+食管胃底左颈部吻合;对既往行胃大部切除术者,行右进胸两切口食管次全切除;并常规行胸-腹二野淋巴结清扫,对于术前可疑颈部淋巴结转移患者,行颈胸腹三野淋巴结清扫,术后标本均送检病理。

2 结果

       本研究共收集食管癌住院患者112例,排除影像质量不合格3例、放弃治疗4例、新辅助保守治疗15例,最终成功入组90例。其中男59例(65.56%)、女31例(34.44%);年龄40~82 (64.3±6.5)岁。多数患者以进食梗阻为主诉(61例,占67.78%)。食管癌定位:上段19例(21.11%)、中段53例(58.89%)、下段18例(20.00%)。

2.1 两名阅片医师一致性分析

       两名阅片医师对MRI联合序列、MDCT分期的Kappa值分别为0.97、0.86,认为两名阅片医师分期结果一致性较好,可信度较高,见表3

表3  两名阅片者Kappa一致性分析
Tab. 3  Kappa consistency analysis of the two subjects

2.2 两种分期方法及病理分期频数分布

       本研究病理分期T1期22例,T2期22例(见图1A1F),T3期34例(见图2A2F),T4a期12例。两种分期方法及病理分期频数分布见表4

图1  男,62岁,食管鳞癌T2期。图1A~1B分别为CT平扫、CT增强,显示食管右侧壁增厚,厚度为9 mm,中等密度肌层受累(箭),分期为T2期。图1C~1D为MRI联合序列(T2-TSE-BLADE+T1-STAR-VIBE-FS),显示食管右侧壁增厚,累及肌层(箭),未及外膜层,T2呈等信号,T1延迟增强呈不均匀低信号,分期为T2期。图1E~1F分别为环切大体标本HE染色2.5倍镜、20倍镜,显示食管右侧壁肿瘤组织侵犯至肌层、未及外膜层,病理分期为T2期。
图2  男,67岁,食管鳞癌T3期。图2A~2B分别为CT平扫、CT增强,显示食管全管周增厚,外膜层清晰(箭),分期为T2期。图2C~2D分别为高分辨T2-TSE-BLADE、T1-STAR-VIBE-FS,显示食管全管周增厚,右后壁外膜层模糊、受累(箭),分期均为T3期。图2E~2F分别为环切大体标本HE染色2.5倍镜、10倍镜,显示食管癌累及全管周,其右后壁肿瘤组织侵犯至外膜层,病理分期为T3期。
Fig. 1  A 62-year-old male patient with esophageal squamous cell carcinoma (stage T2). Figure 1A and 1B are plain CT scan and enhanced CT scan, respectively, showing the thickening of the right esophageal wall with a thickness of 9 mm and the involvement of medium density muscle layer (arrow), which is staged as T2. Figure 1C and 1D are combined MRI sequences (T2-TSE-BLADE and T1-STAR-VIBE-FS). It can be seen that the right esophageal wall is thickened and the muscular layer is involved (arrow) without reaching the adventitia. T2WI is equal signal and delayed enhancement T1WI is uneven low signal. The stage is T2. Figures 1E and 1F are the circumscribed gross specimens with HE staining at 2.5× and 20×, respectively. The tumor tissue of the right esophageal wall invaded the muscular layer, not the adventitia. The pathological stage is T2.
Fig. 2  A 67-year-old male patient with esophageal squamous cell carcinoma (stage T3). Figure 2A and 2B are plain CT scan and enhanced CT scan, respectively. It can be seen that the whole esophagus is thickened and the adventitia is clear (arrow). The stage is T2. Figure 2C and 2D are the images of high-resolution T2-TSE-BLADE and T1-STAR-VIBE-FS, respectively. The esophageal peritubular is thickened, blurred and outer membrane layer of right posterior wall is involved (arrow), and the stage is T3. Figures 2E and 2F show the circumscribed gross specimens stained with HE at 2.5×and 10×, respectively. It can be seen that the whole tube is involved by esophageal cancer, and the tumor tissue of the right posterior wall invades the adventitia. The pathological stage is T3.
表4  各分期方法频数分布表(例)
Tab. 4  Frequency distribution of each staging method (n)

2.3 两种分期方法诊断效能分析

       MRI联合序列分期对T1~T4a期的敏感度分别为94.45%、86.36%、100.00%、66.67%,对T1~T4a期的特异度分别为100.00%、98.53%、87.50%、100.00%,对T1~T4a期的约登指数分别为94.45%、84.89%、87.50%、66.67%。结果表明,MRI联合序列对T分期的敏感度、特异度及约登指数均高于MDCT (除外T1期和T4a期的特异度相同)。两种分期方法诊断效能分析见表56

表5  MRI联合序列分期诊断效能分析
Tab. 5  Analysis of diagnostic efficiency of combined MRI sequences staging
表6  MDCT分期诊断效能分析
Tab. 6  Analysis of diagnostic efficiency of MDCT staging

2.4 MRI联合序列、MDCT及单模态序列分期方法参照病理标准一致性分析

       Kappa值从高到低分别为MRI联合序列(0.91)、T1-STAR-VIBE-FS (0.81)、T2-TSE-BLADE (0.78)、MDCT (0.71),表明MRI联合序列与病理T分期符合度高于单模态序列,更高于MDCT,具有较良好诊断效能。MRI联合序列、MDCT及单模态序列分期方法参照病理标准一致性分析见表7

表7  MRI联合序列、MDCT及单模态序列分期方法参照病理标准的Kappa一致性分析
Tab. 7  Kappa consistency analysis of combined MRI sequences, MDCT and single-mode sequence staging methods with reference to pathological standards

3 讨论

       MRI应用于食管癌T分期的研究由来已久,但多数学者研究是建立在单模态序列基础之上,对于多模态联合序列的T分期临床价值探索较少。既往有文献报道T1-STAR-VIBE-FS序列对早期食管癌诊断效能高优于晚期,T2-TSE-BLADE序列对晚期食管癌诊断效能高于早期[14, 15],因此本研究首次运用MRI联合序列(T1-STAR-VIBE-FS+T2-TSE-BLADE)及MDCT分别对90例食管鳞癌患者进行T分期,对比两者T分期诊断效能,结果表明MRI联合序列分期对T1~T4a期的敏感度、特异度及约登指数均高于MDCT (除外T1期和T4a期的特异度相同);参照病理金标准的Kappa一致性分析得出MRI联合序列的Kappa值明显高于MDCT。由此表明MRI联合序列对食管鳞癌精准T分期具有重要价值。

3.1 高分辨率T2-TSE-BLADE序列、高分辨率T1-STAR-VIBE序列的原理与优势

       食管癌精准T分期对临床治疗方式及预后评估具有至关重要指导意义。MDCT是临床工作中最常用的T分期检查方法,具有检查时间短、伪影少、空间分辨力高等优点,但是软组织分辨力不高影响其分期的准确性。而随着MRI软硬件水平不断提高,能够较好克服食管伪影获得优质图像,并且能够弥补MDCT软组织分辨力不高的缺陷,体现出其T分期的优势。

       高分辨率T2-TSE-BLADE序列:BLADE技术又称螺旋桨技术(Propeller,GE序列称法),主要使用周期性重叠平行性的采集方法,与传统线性K空间采集不同[18]。它可通过算法进行数据校正,分离出旋转及平移运动,从而达到运动纠正、位移校正、旋转校正目的,再通过图像重建,进一步减少刚性运动伪影。此外,BLADE技术对于非刚性运动(如腹部扫描时呼吸运动伪影等)也有减弱作用,并且在临床扫描中还可借助膈肌导航或相位导航等进一步减少运动伪影,这与国内外多位学者运用BLADE序列在上腹部扫描的研究类似[19, 20]。本研究采用BLADE技术与TSE技术相结合方法,TSE具有成像快、信噪比高等优点,扫描过程中加上与呼吸运动一致的膈肌导航,从而获得清晰的食管层次及癌肿外侵情况影像。

       高分辨率T1-STAR-VIBE序列(自由呼吸):传统T1-VIBE技术需要患者配合屏气以克服呼吸伪影,但肺部气腔伪影、食管运动伪影、心脏大血管搏动伪影等仍限制食管成像质量致使影响观察。Radial-VIBE技术K空间填充方式为放射状,采集图像时患者无需屏气,配合均匀自由呼吸即可获得较好图像质量[21],其各类运动伪影均较传统T1-VIBE技术明显减少。Qu等[14]研究发现,Radial-VIBE技术强化峰值可清楚区辨食管各层解剖结构,黏膜层表现为高信号、固有肌层表现为低信号、外膜层表现为高信号。T1-STAR-VIBE技术(自由呼吸)是在Radial-VIBE技术为基础研发,它采用全新的数据采集及重组模式(即层面内采取放射状采样、层间采取笛卡尔采样)[22, 23],联合高效压脂技术(如频率饱和脂肪抑制技术、精准频率反转恢复脂肪抑制技术等),可以明显减轻食管成像的伪影,包括呼吸运动、心脏搏动、食管蠕动、不自主运动等产生的伪影,能够获得比传统3D-VIBE更好的图像信噪比和对比噪声比[24]。因此,T1-STAR-VIBE延迟增强序列在食管检查中具有明显的优势,可清晰显示食管各层结构,尤其食管黏膜及肌层,大大提高了食管癌T分期效能。

3.2 MRI联合序列与MDCT分期结果探讨

       随着MRI技术的发展,越来越多新序列被运用于探讨食管癌T分期,它们对食管正常结构层次、肿瘤组织具有较高分辨力,理论上能够为食管癌分期提供可靠客观依据。其中T1-STAR-VIBE-FS序列能够清晰显示食管黏膜层、肌层,与多位国内外学者[15, 16,25, 26]研究结果相似,对T1~T2期具有较高诊断效能;而T2-TSE-BLADE采用不压脂方式,在管周高信号脂肪组织衬托下能够清晰显示较薄的稍高信号外膜层,对T3期具有较高诊断效能,这与Riddell、Yamada等多名学者[15,27, 28, 29]研究观点相似。较以往研究不同的是,本研究MRI联合序列首次联合了T1-STAR-VIBE-FS序列、T2-TSE-BLADE序列的优势(即可疑早期食管癌运用T1-STAR-VIBE-FS序列分期,可疑晚期食管癌运用T2-TSE-BLADE序列分期),并且以MDCT增强作为对照组,旨在探讨MRI联合序列对比MDCT的T分期诊断效能优劣。

       本研究结果表明,MRI联合序列对食管鳞癌T1-3期的敏感度、特异度及约登指数均高于MDCT,证实了MRI联合序列对食管鳞癌的诊断效能优于MDCT,能够精确区分出食管癌早期(T1~T2期)、晚期(T3~T4期),为术前可切除性评估提供客观依据,为临床手术方式、新辅助放疗或化疗等治疗方案选择提供客观指导。同时,本研究分别对MRI联合序列、单模态序列及MDCT分期方法参照病理标准进行Kappa一致性分析,Kappa值由高而低为MRI联合序列>T1-STAR-VIBE-FS>T2-TSE-BLADE>0.75>MDCT,表明MRI联合序列与病理T分期符合度最高,不仅高于单模态序列,更高于MDCT,具有较良好T分期诊断效能。然而,两种分期方法对T4a期的综合诊断效能均较低,与部分学者研究结果相似[30],一方面可能由于本研究T4a期样本量不足,另一方面仅累及胸膜、胸导管的病例较难被发现,可能与胸膜、胸导管本身解剖结构细小而影像难以发现有关。MRI联合序列除了被运用于食管癌术前T分期外,有些学者[31]还利用它进行食管癌新辅助化疗后的T分期,结果同样表明了具有较高T分期诊断效能。Qu等[32]利用T1-STAR-VIBE-FS、T2-TSE-BLADE序列人工智能提取181例食管癌转移性淋巴结影像组学特征,结果显示了MRI人工智能在食管癌转移性淋巴结识别具有良好潜力。值得注意的是,除了本文研究的MRI联合序列外,还有众多新序列和技术被应用于食管癌的研究。例如众多国内外学者[7,11, 12, 13]运用DWI及ADC序列对食管癌进行疗效评价、病理分级及预后评估等,研究结果表明具有较高临床应用价值,但DWI及ADC序列少见运用于食管癌T分期,可能由于DWI对食管周围伪影敏感、分辨力不足等原因所致。

3.3 本研究不足之处

       (1) T4b期患者大多数接受新辅助治疗而缺乏手术病例,无法对T4b期进行研究;(2)本研究两种分期方法对T4a期诊断效能均不高,可能受该期样本量不足影响,需进一步扩大样本量;(3) MRI联合序列检查时间偏长,需进一步调校优化参数;(4)本研究仅局限于食管鳞癌的T分期,下一步可探索其他病理类型食管癌的分期。另外MRI联合序列对食管鳞癌NM分期、新辅助化疗及放疗疗效评价的探索也有重要临床价值,值得今后关注研究。

       综上所述,MRI联合序列结合了T1-STAR-VIBE-FS、T2-TSE-BLADE序列对食管鳞癌早期、晚期T分期的优势,综合诊断效能明显优于MDCT,是食管鳞癌术前精准T分期的有效方法之一,对于碘过敏、甲亢等CT增强检查禁忌者或者CT分期有疑问者尤其适用。除了T分期外,MRI联合对于食管癌NM分期、人工智能分期、放疗靶区勾勒等方面也具有广阔探索前景。而MDCT虽然T分期效能低于MRI联合序列,但是它具有扫描快、扫描范围不受限制等优点,对NM分期仍能发挥着重要作用。

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