直肠腔内弹性成像对直肠癌新辅助治疗后肿瘤浸润深度降期的评估  

Value of endorectal elastography for predicting the downstage of infiltration depth in rectal cancer after neoadjuvant radiochemotherapy

作　　者：仲光熙[1] 吕珂[1] 戴晴[1] 李建初[1] 姜玉新[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院超声医学科,100730

出　　处：《中华医学超声杂志（电子版）》2016年第1期51-55,共5页Chinese Journal of Medical Ultrasound(Electronic Edition)

摘　　要：目的评估直肠腔内弹性成像应变比值（SR）判断直肠癌新辅助治疗后肿瘤浸润深度（T分期）降期的临床应用价值。方法收集北京协和医院收治的进展期直肠癌（T3期）患者62例,在新辅助放化疗前后,分别行常规直肠腔内超声（ERUS）和直肠腔内弹性成像检查。计算放化疗前后病灶SR差值及SR降幅,以SR降幅判断T分期降期。比较常规ERUS与弹性成像判断T分期降期的准确性。结果放化疗后,58例（58/62,94%）直肠癌病灶的SR值呈明显下降（t=2.823,P〈0.01）,另有4例（7%）SR值升高。pT0-2期的SR平均值为2.20±0.85,pT3期的SR平均值为3.19±0.90,两者差异具有统计学意义（t=3.684,P〈0.01）。以SR降幅≥33.80%判断放化疗后T分期降期的准确性为69%（40/58）,高于常规ERUS的准确性45%（28/62）,但两者差异无统计学意义（P〉0.05）。结合SR降幅,常规ERUS准确诊断降期由14例升高至28例,较好地提高了常规ERUS对T分期降期的诊断准确性。结论应用SR降幅可较好地辅助常规ERUS,提高直肠癌放化疗后T分期降期诊断准确性,为直肠癌新辅助放化疗疗效及预后评估提供一种新型的较为可靠、无创而又简便的影像学方法。Objective To evaluate the value of endorectal elastography with strain ratio measurements for predicting the downstage of T stage in locally advanced rectal cancer after neoadjuvant radiochemotherapy. Methods 62 patients receiving neoadjuvant therapy had twice examinations of conventional endorectal ultrasound（ERUS） and endorectal elastography before radiochemotherapy and surgery. The difference and decreasing amplitude of SR were calculated, the downstage of T stage was predicted by decreasing amplitude of SR. The accuracy of conventional ERUS and endorectal elastography predicting the downstage were compared. Results 58 patients（94%） demonstrated a significant decrease in strain ratios（t=2.823, P 〈0.01）, and 4 patients（6.5%） demonstrated a increase in strain ration. The strain ratios of p T3 rectal cancer were significantly higher than that of p T0-2 rectal cancer（3.19±0.90 vs 2.20±0.85, t=3.684, P 〈0.01）. When the cut-off point of the decreasing amplitude of SR ≥ 33.80%, the accuracy of diagnosis of the downstage of p T stage after chemoradiotherapy by endorectal elastography was 69%（40/58）, which is higher than that of the conventional ERUS（45.1%, 28/62）, but the difference was not statistically significant（P 〈0.05）. The conventional ERUS can correctly diagnosis 28 cases of the downstage increasing from 14 cases with the decreasing amplitude of SR. Conclusions The endorectal elastography with the decreasing amplitude of SR can assist the conventional ERUS, improve the diagnostic accuracy of the downstage of T stage in the rectal cancer after chemoradiotherapy, thereby providing a new reliable, noninvasive and convenient imaging methods for the assessment of the efficacy and prognosis of the rectal cancer after neoadjuvant chemoradiotherapy.

关 键 词：直肠肿瘤 抗肿瘤联合化疗方案 腔内超声检查 弹性成像技术 

分 类 号：R735.37[医药卫生—肿瘤] R445.1[医药卫生—临床医学]