MRI对直肠癌术前评估应用进展  

Recent progress of magnetic resonance imaging of rectal cancer

作　　者：刘立恒[1,2] 靳二虎[1] 王振常[1] 李文武[2] 

机构地区：[1]首都医科大学附属北京友谊医院放射科,北京100050 [2]山东大学附属山东省肿瘤医院放射科,山东省医学科学院,山东济南250117

出　　处：《中华肿瘤防治杂志》2016年第13期897-902,共6页Chinese Journal of Cancer Prevention and Treatment

基　　金：卫生公益性行业科研专项(201402019)

摘　　要：目的对直肠癌准确的术前评估是选择最佳治疗方案的关键,磁共振成像(magnetic resonance imaging,MRI)是最常用影像学方法之一。本研究总结国内外有关MRI在直肠癌术前评估中的研究进展。方法应用PubMed、万方及CNKI数据库检索系统,以"MRI,直肠癌,分期,新辅助治疗"为关键词,检索2011-01-2016-05的相关文献。纳入标准:(1)MRI在直肠癌术前评估中的应用;(2)MRI在直肠癌术前分期与再分期中的应用;(3)MRI对直肠癌新辅助治疗疗效的评价与预测。排除标准:综述、著作和会议汇编等相关文献。根据纳入标准,符合分析文献50篇。结果 MRI在直肠癌定位、T分期中准确性较高,特别是对于环周切缘及壁外血管侵犯的评估,MRI是目前公认的最佳影像学方法。MRI对直肠癌区域淋巴结转移状态的术前预测存在困难,一些淋巴结特异性对比剂如超小超顺磁性氧化铁颗粒的应用可能提高预测准确性。直肠癌新辅助治疗(neoadjuvant chemoradiotherapy,NCRT)后MRI再分期对于制定下一步治疗方案有重要意义,但由于纤维化结缔组织增生反应的影响,再分期的准确性不高。MRI功能成像技术能够对直肠癌NCRT疗效进行有效评估与预测。结论 MRI在直肠癌术前评估中具有重要作用。OBJECTIVE Accurate preoperative evaluation is an essential aspect of decision-making on the treatment for rectal cancer, and magnetic resonance imaging （MRI） plays an critical role in this process. The aim of this article was to summarize the progress of MRI in the preoperative evaluation of rectal cancer. METHODS Papers published between January 2011 and May 2016 were searched, with the key words of ＂MRI, rectal cancer, staging and neoadjuvant chemora diotherapy＂ in Pubmed, Wan Fang and CNKI databases. The inclusion criteria： application of MRI in preoperative evalu- ation of rectal cancer; application of MRI for preoperatively staging and re-staging rectal cancer; application of MRI for e valuating and predicting the effect of neoadjuvant chemoradiotherapy. The exclusion criterion：literatures with types of re- view, meeting compilation or book. A total of 50 articles were included and analyzed according to the criteria. RESULTS MRI of rectal cancer is accurate for the prediction of tumor location and T-staging, and has been considered as the best imaging method for the evaluation of circumferential resection margin and extramural vascular invasion. N-staging still re- mains a challenge in MRI of rectal cancer, but some lymph node specific contrast agents, such as ultrasmall superpara- magnetic iron oxide, may improve the accuracy. Restaging after NCRT is of great importance in the determination of the further treatment; however, the accuracy of restaging by MRI is low because of several NCRT-related factors such as fi- brosis and desmoplastic reaction. Functional MRI techniques could be used to assess and predict the effect of NCRT. CONCLUSION MRI may play an important role in preoperative evaluation of rectal cancer.

关 键 词：直肠肿瘤 MRI 分期 新辅助放化疗 综述文献 

分 类 号：R735.37[医药卫生—肿瘤] R445.2[医药卫生—临床医学]