CT、MRI及TRUS在中低位直肠癌术前T分期中的应用研究  

CT,MRI,and transrectal ultrasound in preoperative T staging of mid-and low rectal cancer

作　　者：李辉[1] 利锡贵 谢雨恩 夏志远 张小龙[1] Li Hui;Li Xigui;Xie Yu’en;Xia Zhiyuan;Zhang Xiaolong(Department of Colorectal&Anal Surgery,The First Affiliated Hospital of Guangxi Medical University,Nanning 530021,Guangxi Zhuang Autonomous Region,China;Department of Diagnostic Ultrasound,The First Affiliated Hospital of Guangxi Medical University,Nanning 530021,Guangxi Zhuang Autonomous Region,China;Department of Radiology,The First Affiliated Hospital of Guangxi Medical University,Nanning 530021,Guangxi Zhuang Auton-omous Region,China;The First School of Clinical Sciences of Guangxi Medical University,Nanning 530021,Guangxi Zhuang Autonomous Region,China)

机构地区：[1]广西医科大学第一附属医院结直肠肛门外科,广西南宁530021 [2]广西医科大学第一附属医院超声诊断科,广西南宁530021 [3]广西医科大学第一附属医院放射学科,广西南宁530021 [4]广西医科大学第一临床医学院,广西南宁530021

出　　处：《结直肠肛门外科》2021年第4期367-370,共4页Journal of Colorectal & Anal Surgery

基　　金：广西医科大学青年科学基金(GXMUYSF201914);广西壮族自治区自然科学基金(2015GXNSFAA139185)。

摘　　要：目的探讨CT、MRI以及TRUS对中低位直肠癌术前T分期的诊断价值。方法回顾性分析2016年10月至2020年6月在广西医科大学第一附属医院结直肠肛门外科就诊的符合条件的308例中低位直肠癌患者的临床资料。收集术前影像学分期与术后病理分期的数据结果,二者完全一致定义为准确,对比分析CT、MRI和TRUS三种检查的准确率。结果CT、MRI和TRUS诊断直肠癌T分期的准确率分别为70.1%、82.5%、81.8%,三者比较差异有统计学意义(P<0.05),其中MRI和TRUS诊断T分期的准确率比较差异无统计学意义(P>0.05);CT诊断T分期的准确率为70.1%,低于MRI和TRUS的准确率(均P<0.05)。三种检查方法诊断T_(1)~T_(3)期的准确率比较差异均有统计学意义(均P<0.05),诊断T_(4)期的准确率比较差异无统计学意义(P>0.05)。进一步的两两比较结果发现,TRUS诊断T_(1)期的准确率为90.5%,高于CT的47.6%(P<0.05),MRI和TRUS、MRI和CT诊断T_(1)期的准确率比较差异均无统计学意义(均P>0.05);MRI与CT诊断T_(2)期的准确率比较差异无统计学意义(P>0.05),TRUS诊断T_(2)期的准确率为89.7%,高于MRI、CT的准确率(均P<0.05);MRI诊断T_(3)期的准确率为86.7%,高于CT的73.4%(P<0.05),MRI和TRUS、TRUS和CT诊断T_(3)期的准确率比较差异均无统计学意义(均P>0.05)。结论在中低位直肠癌术前T分期的诊断中,MRI和TRUS相比CT均具有更高的准确率,应作为常规的检查方法,而对于诊断局部早期中低位直肠癌特别是T_(2)期直肠癌,TRUS的可信度更高。综合MRI和TRUS得出最终的临床分期,可更好地指导临床治疗。Objectives To investigate the value of multi-slice spiral computed tomography(CT),magnetic resonance imaging(MRI),and trans-rectal ultrasound(TRUS)in preoperative T staging of mid-and low rectal cancer.Methods This was a retro⁃spective analysis of 308 patients with mid-and low rectal cancer confirmed by pathology between October 2016 and June 2020 at the First Affiliated Hospital of Guangxi Medical University.The agreement between preoperative T staging by various imaging modalities and postoperative T staging was analyzed and compared.Results The overall accuracy of T staging was 70.1%by CT,82.5%by MRI,and 81.8%by TRUS.MRI and TRUS had comparable staging accuracy,and both had higher accuracy than CT in preoperative T staging(P<0.05).The accuracy was significantly different according to different T staging(T_(1)~T_(3))(P<0.05).The accuracy of TRUS(90.5%)in T_(1) staging was significantly higher than that of CT(47.6%)(P<0.05).There was no significant difference in the accuracy of MRI and TRUS,MRI and CT of T_(1) staging diagnosis(P>0.05).The accuracy of MRI and CT in T_(2) staging was not statistically significant(P>0.05),but both were lower than that of TRUS(89.7%),and the difference was statistical⁃ly significant(P<0.05).The accuracy of MRI(86.7%)in T_(3) staging was higher than that of CT(73.4%),and the difference was statistically significant(P<0.05).There was no significant difference in the accuracy of MRI and TRUS,TRUS and CT of T_(3) stag⁃ing diagnosis(P>0.05).Conclusion In preoperative T staging of mid-and low rectal cancer,both MRI and TRUS have higher accuracy than CT and should be used as a routine examination method.Among the two methods,TRUS has higher reliability for local early mid-and low rectal cancer staging,especially T_(2) staging.In conclusion,the combination of MRI and TRUS can stage rectal cancer and guide clinical treatment.

关 键 词：直肠癌 T分期 CT MRI TRUS 

分 类 号：R735.37[医药卫生—肿瘤]