直肠癌放疗前后磁共振特征对发生重度慢性放射性直肠损伤的预测价值  

Predictive value of magnetic resonance imaging characteristics before and after radiotherapy for the occurrence of severe radiation-induced late rectal injury in patients with rectal cancer

作　　者：吴小媚 李亚军 谢佩怡[1] 潘希敏 牛可馨 曹务腾[1] 马腾辉[3] 孟晓春[1] Wu Xiaomei;Li Yajun;Xie Peiyi;Pan Ximin;Niu Kexin;Cao Wuteng;Ma Tenghui;Meng Xiaochun(Department of Radiology,the Sixth Affiliated Hospital,Sun Yat-sen University,Guangzhou 510655,China;Department of Radiology,Guangdong Provincial People's Hospital,Guangzhou 510080,China;Department of Colorectal Surgery,the Sixth Affiliated Hospital,Sun Yat-sen University,Guangzhou 510655,China)

机构地区：[1]中山大学附属第六医院放射科,广州510655 [2]广东省人民医院放射科,广州510080 [3]中山大学附属第六医院结直肠外科,广州510655

出　　处：《中华胃肠外科杂志》2021年第11期991-997,共7页Chinese Journal of Gastrointestinal Surgery

基　　金：国家自然科学基金(81902867);广东省自然科学基金(2021A1515011795)。

摘　　要：目的重度慢性放射性直肠损伤(sRLRI)严重影响直肠癌患者的生活质量,术前预测sRLRI发生风险能够为指导手术决策和围手术期管理提供重要信息。本研究探讨直肠癌放疗前后磁共振特征对发生重度慢性放射性直肠损伤的预测价值。方法采用诊断性研究方法。收集2013年1月至2018年7月期间,于中山大学附属第六医院放射科接受长程放疗的90例直肠癌患者的临床及影像资料。病例纳入标准:(1)经病理确诊为直肠癌,年龄≥18岁的患者;(2)接受新辅助放化疗且进行前切除术;(3)随访时间≥3年;(4)既往无其他肿瘤性疾病。排除未在放疗前2周内及放疗结束后8周内接受MRI检查、图像较差无法评估者以及病历资料不完整或存在严重胃肠道疾病者。根据放射性损伤分级标准(RTOG/EORTC),需要手术的3~4级严重并发症定义为sRLRI。观察放疗前后T2WI图像测量无肿瘤部位的直肠壁厚度、膀胱壁厚度、直肠骶骨间距,以及直肠壁表观弥散系数(ADC)值。采用受试者工作特征(ROC)曲线评价上述指标对sRLRI的预测价值。结果90例直肠癌患者中,sRLRI者34例(37.8%)。放疗前,sRLRI者与非sRLRI者的直肠壁厚度中位数分别为4.530 mm和4.355 mm,膀胱壁厚度中位数分别为3.962 mm和3.868 mm,直肠骶骨间距中位数分别为15.557 mm和12.433 mm,直肠壁ADC值中位数分别为1.620×10^(-3)mm^(2)/s和1.653×10^(-3)mm^(2)/s;差异均无统计学意义(均P>0.05)。放疗后MRI测量结果中,与非sRLRI者比较,sRLRI者的直肠壁厚度(中位数:8.239 mm比6.223 mm,Z=-3.512,P=0.001)更厚,直肠骶骨间距(中位数:17.728 mm比13.885 mm,Z=-2.247,P=0.025)更长,放疗前后直肠壁厚度变化率(中位数:98.106%比49.584%,Z=-4.169,P<0.001)更大,差异均具有统计学意义(均P<0.05)。放疗后,两组间膀胱壁厚度及其变化率、直肠壁ADC率及其变化率的差异均无统计学意义(均P>0.05)。放疗前后直肠壁厚度变化率、放疗后直�Objective Severe radiation-induced late rectal injury(sRLRI)directly affects the quality of life of patients with rectal cancer.Effective prediction of sRLRI before surgery may provide important information for the selection of surgical strategies and perioperative managements.The purpose of this study is to evaluate the feasibility of predicting sRLRI based on magnetic resonance imaging(MRI)features before and after radiotherapy for rectal cancer.Methods This was a diagnostic study.Clinical and imaging data of 90 patients with rectal cancer receiving long-term radiotherapy from June 2013 to July 2018 in the Sixth Affiliated Hospital of Sun Yat-sen University were collected retrospectively.Case inclusion criteria:(1)rectal cancer was diagnosed by pathology and age of≥18 years old;(2)patients received neoadjuvant chemoradiotherapy and anterior rectal resection;(3)follow up time≥3 years;(4)patients had no history of other neoplasm.Exclusion criteria:(1)patients did not receive MRI examination in our hospital within 2 weeks before and/or 8 weeks after radiotherapy;(2)images were not good enough for evaluation;(3)medical records were incomplete;(4)patients had severe gastrointestinal diseases.According to the RTOG/EORTC classification criteria for radiation reactions,severe complications of grade 3-4 requiring surgical management were defined as sRLRI.T2WI and DWI images before and after radiotherapy were evaluated.The rectal wall thickness,bladder wall thickness,rectal sacral spacing and apparent diffusion coefficient(ADC)were measured.The receiver operating characteristic(ROC)curve was used to evaluate the predictive value of the above indicators for sRLRI.Results Among the 90 patients with rectal cancer,34(37.8%)developed sRLRI.Before radiotherapy,the median rectal wall thickness of sRLRI and non-sRLRI patients was 4.530 mm and 4.355 mm,respectively;the median bladder wall thickness was 3.962 mm and 3.868 mm,respectively;the median rectal sacral spacing was 15.557 mm and 12.433 mm,respectively;the median ADC v

关 键 词：直肠肿瘤 新辅助放化疗 磁共振成像 表观弥散系数 

分 类 号：R735.37[医药卫生—肿瘤]