盆腔增强CT和MRI在局部复发直肠癌多器官联合切除中应用价值研究  

Value of enhanced pelvic computed tomography and magnetic resonance imaging in the diagnosis and multivisceral resection of locally recurrent rectal cancer

作　　者：李震洋[1] 周林江 周珉玮 臧怡雯[1] 周易明[1] 顾晓冬[1] 杨逸[1] 陈宗祐[1] 项建斌[1] LI Zhen-yang;ZHOU Lin-jiang;ZHOU Min-wei(Department of General Surgery,Huashan Hospital Affiliated to Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华山医院外科,上海200040 [2]复旦大学附属华山医院放射科,上海200040

出　　处：《中国实用外科杂志》2020年第10期1177-1180,共4页Chinese Journal of Practical Surgery

基　　金：上海市科学技术委员会科研计划项目(No.134119a1400)。

摘　　要：目的探讨盆腔增强CT和MRI在局部复发直肠癌(LRRC)多器官联合切除中的价值。方法回顾性分析2012年1月至2018年12月复旦大学附属华山医院外科收治的行手术治疗的48例LRRC病人的临床资料,病理组织保存完整。LRRC根据纪念斯隆-凯特琳癌症中心(MSKCC)标准分为中央型、前向型、后向型和侧向型。术前均行腹部增强CT和盆腔平扫+增强MRI检查。比较CT和MRI对LRRC术前诊断准确率、对邻近器官侵犯的预测价值,并分析二者融合图像对手术的指导作用。结果48例病人中41例(85.4%)经术后病理学检查确诊直肠癌术后复发。MRI和CT对LRRC检出率分别为95.1%(39/41)和87.8%(36/41),差异无统计学意义(χ^2=1.406,P=0.236),MRI诊断LRRC的准确率高于CT[91.7%(44/48)vs.77.1%(37/48),χ^2=3.872,P=0.049]。盆腔增强CT及MRI鉴别LRRC累及邻近器官的准确率分别为70.8%(34/48)和68.7%(33/48),差异无统计学意义(χ^2=0.049,P=0.824)。各LRRC亚型分析提示,增强CT的鉴别准确率:后向型100%(7/7)、侧向型71.4%(5/7)、中央型69.6%(16/23)、前向型54.6%(6/11);盆腔增强MRI的鉴别准确率:中央型78.3%(18/23)、前向型63.6%(7/11)、后向型57.1%(4/7)和侧向型57.1%(4/7)。所有病人均顺利完成手术,R0切除率为85.4%(41/48)。结论推荐增强MRI检查作为LRRC诊断辅助手段;增强CT对后向型LRRC骶尾骨侵犯检出率高,而增强MRI判断中央型LRRC准确率较高;多模态融合图像有助于确定LRRC手术切除范围并制定策略。ObjectiveTo analyze the clinical value of computed tomography(CT)and magnetic resonance imaging(MRI)in patients with locally recurrent rectal cancer(LRRC).MethodsThe complete clinical and pathological data of48 LRRC patients treated by surgery in Huashan Hospital Affiliated to Fudan University from January 2012 to December2018 were analyzed retrospectively.According to the criteria of Memorial Sloan Kettering Cancer Center(MSKCC),thepatients were divided into central,anterior,posterior,and lateral subtypes.All patients received preoperative abdominalenhanced CT,pelvic plain and enhanced MRI.The preoperative diagnostic accuracy of LRRC and the predictive value oftumor invasion scope by enhanced pelvic CT and MRI were compared.ResultsCombined with postoperativepathological data,41 patients(85.4%)were diagnosed with postoperative locally recurrence of rectal cancer in 48 cases.The accuracy of MRI was higher than CT significantly[91.7%(44/48)vs.77.1%(37/48),χ^2=3.872,P=0.049].However,there was no significant difference in the sensitivity[95.1%(39/41)vs.87.8%(36/41),χ^2=1.406,P=0.236]between thetwo methods.The accuracy of pelvic enhanced CT and MRI in evaluating tumor invasion scope was 70.8%(34/48)and 68.7%(33/48)respectively,with no significantdifference(χ^2=0.049,P=0.824).The diagnosticaccuracy of enhanced CT for tumor invasion was100%(7/7)in posterior subtypes,71.4%(5/7)inlateral subtypes,69.6%(16/23)in central subtypesand 54.6%(6/11)in anterior subtypes.The diagnosticaccuracy of enhanced MRI was 78.3%(18/23)in central subtypes,63.6%(7/11)in anterior subtypes,57.1%(4/7)in posterior subtypes and 57.1%(4/7)in lateral subtypes.All the surgeries were successfully completed,with an R0 resection rate of 85.4%(41/48).ConclusionEnhanced MRIis recommended as an auxiliary method for qualitative diagnosis of LRRC.Enhanced CT has a high detection rate forposterior subtypes of LRRC with sacrococcygeal invasion,while enhanced MRI has a high accuracy in the determinationof central subtypes.Multi-modality image fusion could be

关 键 词：局部复发直肠癌 计算机断层扫描 磁共振成像 多模态影像融合 

分 类 号：R6[医药卫生—外科学]