磁共振多模态成像在直肠癌诊断和术前分期的应用价值  

Application Value of Multimodal MRI in the diagnosis and preoperative staging of rectal cancer

作　　者：黄文光[1] 张福洲 戚婉[3] 冯浩[1] 母青林 HUANG Wenguang;ZHANG Fuzhou;QI Wan;FENG Hao;MU Qinglin(Department of Radiology,The First People’s Hospital of Guangyuan,Guangyuan 628017,Sichuan,China;Department of Medical Imaging,Nanchong Central Hospital,Nanchong 637000,Sichuan,China;The Affiliated People’s Hospital of Fujian University of TCM,Fuzhou 350004,China)

机构地区：[1]广元市第一人民医院放射科,四川广元628017 [2]南充市中心医院影像科,四川南充637000 [3]福建中医药大学附属人民医院,福建福州350004

出　　处：《西部医学》2020年第8期1224-1228,1233,共6页Medical Journal of West China

基　　金：四川省医学科研课题(S15049);广元市市级科研项目(2017ZCZDYF030)。

摘　　要：目的探讨多模态磁共振(T2WI+双b值DWI)在直肠癌诊断和术前分期中的应用价值。方法回顾性分析2017年9月~2019年12月在广元市第一人民医院经手术病理证实的43例原发性直肠癌患者的MRI影像和结肠镜检资料,通过MRI资料分析直肠癌T分期、N分期、MRF状态、EMVI状态和肿瘤下缘到肛缘距离并获得DISTANCE报告,对比治疗前磁共振DISTANCE评估报告的TN评估结果与术后病理TN分期的一致性,计算MRI检查的准确率、灵敏性及特异性。结果多模态磁共振共正确评估T分期直肠癌患者38例,总体准确率为88.37%,对T1-2期、T3期、T4期的诊断准确性、灵敏度、特异度分别为T1-2期:93.02%、100%、92.11%,T3期:88.37%、88.57%、87.50%,T4期:95.35%、66.67%、97.50%,表明MRI对直肠癌患者的T分期结果与病理结果的一致性较高。MRI正确评估N分期直肠癌患者32例,总体准确率为74.42%,对NO期、N1期、N2期的诊断准确性、灵敏度、特异度分别为N0期:88.37%、78.95%、95.83%,N1期:74.42%、72.20%、76.00%,N2期:86.05%、66.67%、89.19%,表明两者相关程度中等。结论多模态磁共振成像可以实现对直肠癌患者的术前分期诊断,且对T分期的诊断准确性优于N分期,尤其体现在对T1-T2分期的诊断效果,对临床直肠癌患者的术前诊断具有重要指导价值。Objective To investigate the application value of multimodal magnetic resonance imaging(MRI),which contains high resolution and double b value diffusion-weighted magnetic resonance imaging(DWI),combined with colonoscopy in the field of diagnosis and preoperative staging of rectal cancer.Methods Retrospective analysis was conducted with the MRI and colonoscopy data of 43 selected cases of patients with rectal cancer confirmed by operation and pathology from September 2017 to December 2019 in the First People’s Hospital of Guangyuan.The T staging,N staging,MRF status,EMVI status and distance from the lower edge of the tumor to anal margin of each rectal cancer patient were assessed from MRI images.Finally,the“DISTANCE”evaluation report was obtained.The comparison between the T and N staging results from MRI“DISTANCE”report and postoperative pathology was performed to understand the accuracy of MRI diagnosis.Results 38 patients were assessed correctly on T staging by MRI and the overall diagnostic accuracy reached to 88.37%.The accuracy,sensitivity and specificity of MRI on T1 and T2 stages are 93.02%,100%,92.11%.Those of the T3 stage are 88.37%,88.57%,87.50%and the T4 stage are 95.35%,66.67%,97.50%,respectively.It could demonstrate the strong consistency between MRI diagnosis on preoperative T staging and pathological T staging of rectal cancer.32 patients were assessed correctly on N staging by MRI with overall diagnostic accuracy of 74.42%.The accuracy,sensitivity and specificity demonstrated in three N stages are as following:88.37%,78.95%,95.83%in N0 stage.74.42%,72.2%,76.00%in N1 stage and 86.05%,66.67%,89.19%in N2 stage,respectively,which shown that the correlation between MRI in N staging and pathological N staging of rectal cancer remaining at a moderate level.Conclusion Multimodal MRI(high resolution+double b value DWI)has a great value on the staging diagnosis of rectal cancer patients,especially on T1-T2 staging.Besides,the accuracy of T staging is better than N staging,which is of significance

关 键 词：多模态磁共振成像 直肠癌 诊断 TN术前分期 DISTANCE评估 

分 类 号：R445.2[医药卫生—影像医学与核医学] R735.3[医药卫生—诊断学]