3.0T高分辨MRI诊断直肠癌直肠系膜淋巴结转移的应用价值  

Diagnostic accuracy of 3.0T high-resolution MRI for assessment mesorectal lymph node metastases in patients with rectal cancer

作　　者：陈琰 杨心悦[1] 卢宝兰 肖晓娟[2] 庄晓曌[3] 余深平[1] Chen Yan;Yang Xinyue;Lu Baolan;Xiao Xiaojuan;Zhuang Xiaozhao;Yu Shenping(Department of Radiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China;Department of Radiology, Peking University Shenzhen Hospital, Shenzhen 518036, China;Department of Radiology, Hainan General Hospital, Hoikou 570311, China)

机构地区：[1]中山大学附属第一医院放射科,广州510080 [2]北京大学深圳医院放射科,518036 [3]海南省人民医院放射科,海口570311

出　　处：《中华胃肠外科杂志》2018年第7期786-792,共7页Chinese Journal of Gastrointestinal Surgery

基　　金：广东省科技计划（2014A020212126）;海南省社会发展科技专项（SF201405）

摘　　要：目的探讨3.0T高分辨MRI对直肠癌直肠系膜淋巴结转移的诊断价值。方法采用描述性病例系列研究方法，回顾性收集中山大学附属第一医院2015年11月至2016年11月期间经病理证实为原发直肠癌且术前行3.0T直肠2D高分辨MRI检查患者的影像学和术后病理资料，纳入患者的手术时间需距术前MRI检查不超过2周，排除术前接受放疗、化疗或同期放化疗者以及MRI检查后未行手术者。MRI扫描序列包括高分辨矢状位、冠状位、正交轴位T2加权像（T2WI），重复时间为3000-4000 ms，回波时间为77-87 ms，层厚均为3 mm，无间隔扫描，视野为18-22 cm。两名腹部MRI诊断医师分别测量淋巴结最短径（各测量3次取平均值），观察淋巴结形态、边缘及信号特征。高分辨MRI T2WI评价淋巴结转移标准为形态不规则、边缘模糊和（或）信号混杂。将术前MRI诊断淋巴结有无转移的结果与术后病理结果进行对照，计算高分辨MRI评价直肠系膜淋巴结及不同短径淋巴结转移的灵敏度、特异度、准确性、阳性预测值（PPV）、阴性预测值（NPV），并采用Kappa检验评价高分辨MRI与病理结果的一致性。Kappa值为0-0.20为一致性极低，0.21-0.40为一致性一般，0.41-0.60为一致性中等，0.61-0.80为高度一致性，0.81-1.00为几乎完全一致。结果共81例患者纳入本研究，其中男50例、女31例，年龄为（59.3±11.1）岁。病理诊断为高分化腺癌1例、中分化腺癌63例、中-低分化腺癌9例、低分化腺癌2例、黏液腺癌3例、绒毛管状腺癌3例；T1期2例、T2期20例、T3期45例、T4期14例；N0期34例、N1期40例、N2期7例；M0期76例、M1期5例。MRI与病理相匹配淋巴结共377枚，168枚（44.6%）为转移淋巴结，58.0%（47/81）的患者淋巴结转移阳性。转移淋巴结短径的中位数为5.4（2.4-18.6）mm，长于未转移淋巴结的短径[中位数3.8（2.0-8.7）mm，Z=10.586，P = 0.000]。�Objective To evaluate the diagnostic value of 3.0T high-resolution MRI in mesorectal lymph node metastasis of rectal cancer. Methods The images and postoperative pathological data of patients with pathologically diagnosed rectal cancer who underwent prospective 3.0T two dimensional high-resolution MRI rectal examinations and surgery within two weeks after MRI examination at the First Affiliated Hospital, Sun Yat-sen University from November 2015 to November 2016 were retrospectively collected. Patients who received preoperative neoadjuvant therapy and those who did not undergo operation after MRI examination were excluded. The MRI sequences included high- resolution sagittal, coronal and oblique axial T2 weighted image （T2WI） （repetition time/echo time, 3000-4000 ms/77-87 ms; slice thickness/gap, 3 ram/0 mm; field of view, 18-22 cm）. Two abdominal MRI radiologists independently assessed the morphology, margin, signal of all visible mesorectal nodes, measured their minor axes （three times for each radiologist） and gave estimation of the malignancy. The criteria of metastatic nodes on high-resolution MRI T2WI were nodes with irregular shape, ill-defined border and/or heterogeneous signal. The results of MRI diagnosis were compared with postoperative pathology. The sensitivity, specificity, accuracy, positive predictive value （PPV） and negative predictive value （NPV） of mesorectal nodes and nodes with different short-axis diameter ranges were calculated to evaluate the diagnostic efficiency of high-resolution MRI. Kappa statistics was used to evaluate the agreement for per node and for per patient between high-resolution MRI and pathological results. A Kappa value of 0-0.20 indicated poor agreement; 0.21-0.40 fair agreement; 0.41-0.60 moderate agreement; 0.61-0.80 good agreement; and 0.81-1.00 excellent agreement. Results A total of 81 patients were enrolled in the retrospective cohort study, including 50 males and 31 females with age of （59.3 ±11.1） years. Histopathology showed 1 case of we

关 键 词：直肠肿瘤 直肠系膜淋巴结 磁共振成像 高分辨 

分 类 号：R445.2[医药卫生—影像医学与核医学] R735.37[医药卫生—诊断学]