磁共振成像在进展期直肠癌淋巴结转移以及新辅助治疗后淋巴结再分期中的应用  

Application of magnetic resonance imaging in lymph node metastasis of advanced rectal cancer and lymph node re-staging after neoadjuvant therapy

作　　者：张朝赫 于韬 董越 罗娅红 ZHANG Zhaohe;YU Tao;DONG Yue;LUO Yahong(Department of Medical Imaging,Cancer Hospital of China Medical University,Liaoning Cancer Hospital&Institute,Liaoning Shenyang 110042,China)

机构地区：[1]中国医科大学肿瘤医院(辽宁省肿瘤医院)医学影像科,辽宁沈阳110042

出　　处：《现代肿瘤医学》2021年第6期1067-1070,共4页Journal of Modern Oncology

基　　金：辽宁省中央引导地方科技发展专项资金(编号:2018416029)。

摘　　要：术前新辅助放化疗是局部进展期直肠癌(cT 3-4或cN+)综合治疗的重要组成部分。治疗前准确评估淋巴结状态以及新辅助治疗后的淋巴结再分期对临床医师的诊疗决策以及患者的预后评估有着重要意义。高分辨磁共振成像(high resolution magnetic resonance imaging,HR-MRI)、弥散加权磁共振成像(diffusion weighted imaging,DWI)、体素内不相干运动扩散加权成像(intravoxel incoherent motion magnetic resonance imaging,IVIM-DWI)、动态增强磁共振成像(dynamic contrast magnetic resonance imaging,DCE-MRI)以及影像组学等技术的不断发展,为MRI精准评估直肠癌淋巴结转移开辟了新途径。DWI、IVIM、DCE-MRI等功能MRI成像可以从扩散与灌注角度对淋巴结进行定量与半定量分析,但不同参数之间存在重叠,不同中心的研究结果并不统一;影像组学通过高通量提取影像组学特征联合多种临床预测因子建立的诊断与预测模型对直肠癌淋巴结转移也显示出了良好的预测潜能,但该技术尚处于研究阶段。因此多种影像技术的结合以及人工智能的发展才是提高淋巴结诊断准确率的重要途径。本文就磁共振成像在直肠癌淋巴结转移以及新辅助治疗后淋巴结再分期中的应用进行综述,以期为临床提供参考。Preoperative neoadjuvant therapy is the important part of the comprehensive treatment of locally advanced rectal cancer(cT 3-4 or cN+).Accurate assessment of lymph node status before treatment and re-staging of lymph nodes after neoadjuvant therapy are of great significance to clinicians'diagnosis and treatment decisions and prognostic assessment of patients.HR-MRI,DWI,IVIM-DWI,DCE-MRI,and radiomics opened a new wayfor lymph node metastasis assessment accurately.DWI,IVIM,DCE-MRI and other functional MRI imaging can quantitatively and semi-quantitatively analyze lymph nodes from the perspective of diffusion and perfusion,however there is overlap between different parameters,and the research results of different centers are not uniform.Radiomics through high-throughput extracting radiomics features and combining multiple clinical predictors to establish diagnostic and predictive models also shows good predictive potential for rectal cancer lymph node metastasis,but the technology is still in the research stage.Therefore,the combination of multiple imaging technologies and the development of artificial intelligence are the important ways to improve the accuracy of lymph node diagnosis.This article reviews the application of magnetic resonance imaging in lymph node metastasis of rectal cancer and lymph node re-staging after neoadjuvant therapy,in order to provide clinical reference.

关 键 词：直肠癌 淋巴结转移 新辅助治疗 磁共振成像 淋巴结分期 

分 类 号：R735.3[医药卫生—肿瘤]