3.0 T MRI在直肠癌术前分期和评估中的应用价值

Clinical value of 3.0 T MRI in the preoperative staging and assessment of rectal cancer

关键词:  直肠肿瘤  磁共振成像  直肠癌  T分期  术前评估  病理

Key words:  rectal neoplasms  magnetic resonance imaging  rectal cancer  T staging  preoperative assessment  pathology

摘要:

目的　探讨3.0 T MRI在直肠癌术前分期和评估中的应用价值。方法　收集经肠镜及病理确诊的76例直肠癌患者资料，通过术前MRI影像判断T分期、N分期并测量肿瘤下缘至肛缘距离，将MRI分期和评估结果与术后病理进行对照分析。结果　MRI诊断T1期9例，T2期19例，T3期32例，T4a期14例，T4b期2例。病理诊断T1期9例，T2期22例，T3期28例，T4a期15例，T4b期2例。MRI T1、T2、T3、T4a、T4b期诊断敏感度和特异度分别为67%和100%、68.2%和92.6%、89.3%和85.4%、80.0%和96.7%、100%和100%，两者一致性较好（Kappa=0.708，P＜0.05）。MRI诊断肠旁淋巴结转移36例，术后病理诊断肠旁淋巴结转移33例， MRI诊断肠旁淋巴结转移敏感度、特异度分别为85.2%和83.3%（Kappa=0.701，P＜0.05）。76例患者中有12例患者行Miles术，术前均通过MRI曲线测量技术测量肿瘤下缘至肛缘距离，与术后病理标本数据进行对比，差值≤7 mm，差异无统计学意义（t=0.480，P＞0.05）。结论　3.0 T MRI可准确地对直肠癌患者进行术前分期和评估，为临床诊疗提供帮助。

Abstract:

Objective　To investigate the value of 3.0 T MRI in preoperative staging and assessment of rectal cancer. Methods　Clinical data of 76 patients with rectal cancer confirmed by colonoscopy and pathology were collected. Preoperative MRI images were used to determine the T stage and N stage, and the lower edge of the tumor to anal was measured. The MRI staging and evaluation results were compared with the postoperative pathology. Results　According to MRI, 9 cases were diagnosed in T1, 19 cases in T2, 32 cases in T3, 14 cases in T4a, and 2 cases in T4b. Pathological examination revealed 9 cases in T1, 22 cases in T2, 28 cases in T3, 15 cases in T4a and 2 cases in T4b. The diagnostic sensitivity and specificity of MRI in T1, T2, T3, T4a and T4b stage rectal cancers were 67% and 100%, 68.2% and 92.6%, 89.3% and 85.4%, 80.0% and 96.7%, 100% and 100%, respectively. The results of MRI were correlated well with the results of pathology (Kappa=0.708, P<0.05). Paracolic lymphatic metastasis was noted in 36 patients by MRI and 33 patients by postoperative pathology. The sensitivity and specificity for MRI diagnosis were 85.2% and 83.3%, respectively (Kappa=0.701, P<0.05). Among the 76 patients, 12 underwent Miles operation. The distance between the lower edge of the tumor and the anal edge was measured by MRI using curve measurement technique before operation. Compared with the data of pathological specimens after operation, the difference was less than 7 mm, and there was no significant difference (t=0.480，P＞0.05). Conclusion　3.0 T MRI can deliver accurate information on preoperative staging and evaluation in rectal cancer patients, and provide assistance for clinical diagnosis and treatment.