磁共振三维成像在早期评价直肠癌新辅助治疗疗效中的价值  

The value of MRI with CUBE sequence in early evaluation of the efficacy of neoadjuvant therapy for locally advanced rectal cancer

作　　者：王馨华[1] 曹务腾[1] 刘得超 李芳倩[1] 李雯莉[1] 康亮 邓艳红 周智洋[1] 

机构地区：[1]中山大学附属第六医院放射科数字影像学实验室,广州510065 [2]结直肠外科 [3]肿瘤内科

出　　处：《中华胃肠外科杂志》2018年第1期73-78,共6页Chinese Journal of Gastrointestinal Surgery

基　　金：广东省自然科学基金项目（2015A030313109）;广州市科技计划项目（201607010030）

摘　　要：目的探讨磁共振三维快速自旋回波序列（CUBE）成像在早期评价直肠癌新辅助治疗（NAT）疗效中的价值。方法病例纳入标准：（1）经病理活检证实为直肠癌；（2）治疗前MRI诊断为局部进展期直肠癌（T3。或淋巴结阳性），病变下端距离肛缘12cm内；（3）接受并符合NAT治疗条件并按要求完成；（4）在NAT前和化疗（包括新辅助化疗和新辅助放化疗中化疗）2程结束后，完成直肠常规MRI序列扫描及CUBE扫描；（5）在NAT后6～8周行手术治疗。同时，排除曾因直肠恶性肿瘤或其他器官肿瘤进行过NAT、术前MRI常规图像质量不足以用于直肠癌分期或CUBE图像质量不足以进行体积测量的患者。根据上述标准，收集中山大学附属第六医院2014年2月至2016年1月间确诊为直肠癌的50例患者。所有患者均分别在新辅助治疗前以及治疗后（化疗2程后），行直肠MRI常规序列及CUBE成像序列扫描检查。根据手术后的肿瘤病理，按照消退分级标准，分为敏感组（0—2级）和不敏感组（3级）。分别在CUBE图像上测量两组患者治疗前、后瘤体的体积值，并对其变化程度的差异进行比较。体积差值=治疗前体积值一治疗后体积值，体积变化率=（治疗前体积值一治疗后体积值）／治疗前体积。运用受试者工作特征（ROC）曲线评估CUBE的有关定量参数预测直肠癌NAT疗效的价值。结果50例直肠癌患者中，男性31例，女性19例，平均年龄49．1（21～70）岁。NAT前MR1分期T2N1-2：期1例，T3期43例，T4期6例。接受NAT后，敏感组45例（包括病理消退分级0级14例，1级13例，2级18例），不敏感组5例（病理消退分级3级5例）。本组直肠癌患者在NAT前中位肿瘤体积为18．70（4．14～91．77）cm。，化疗2程后中位肿瘤体积为9．26（1．02～52．58）cms，差异有统计学意义（U=-5．826，P=0．000）。在接受NAT前和化疗2程后�Objective To investigate the value of MRI with CUBE sequence in early evaluation of the efficacy of neoadjuvant therapy （NAT） for locally advanced rectal cancer. Methods Inclusion criteria： （1） rectal cancer proven by biopsy; （2） locally advanced rectal cancer （T3-4 or positive lymph nodes） with distance from lower edge of tumor to anal verge within 12 cm diagnosed by MRI before NAT; （3） acceptance of NAT treatment regulations and completion of NAT; （4） completion of routine MRI scan and CUBE scan before and after 2-course NAT chemotherapy （including new neoadjuvant chemotherapy and chemoradiotherapy）; （5） completion of surgery 6-8 weeks after NAT; （6） exclusion of any previous NAT due to rectal malignant tumor or other tumors; （7） exclusion of poor image quality of preoperative routine MRI insufficient for rectal cancer staging or of CUBE image insufficient for tumor volume measurement. Fifty patients with advanced local rectal cancer were recruited in our hospital from February 2014 to January 2016. All the patients underwent MRI before and after 2-course neoadjuvent therapy. Tumor volume on CUBE were measured and the volume changes were calculated： volume difference= pre-treatment volume-post-treatment volume, volume change rate= （pre-treatment volume-post-treatment volume）/ pre-treatment volume. All the patients were categorized into sensitive and non-sensitive group according to postsurgical pathology. Comparisons were made between both groups before and after therapy. ROC curve was used to evaluate the value of CUBE- associated parameters in predicting the efficacy of rectal cancer. Results Among enrolled 50 patients with rectal cancer, 31 were male and 19 were female, with mean age of 49.1 years （range 21 to 70 years）. T-staging by MRI before NAT was T2N1-2 in 1 case, T3 in 43 cases, T4 in 6 cases. The number of patients after NAT from tumor regression grading （TRG） 0 to TRG3 was 14, 13, 18, 5, respectively. The sensitive group and insensitive group w

关 键 词：直肠肿瘤 磁共振成像 三维快速自旋回波序列 新辅助治疗 

分 类 号：R735.37[医药卫生—肿瘤]