高分辨率MRI对直肠癌术前TN分期、环周切缘及壁外血管受侵、淋巴结转移诊断的准确性研究  

Diagnostic Accuracy of High-resolution MRI for Preoperative TN staging,Circumferential Resection Margin Assessment,Extramural Vascular Invasion Detection,and Lymph Node Metastasis Identification in Rectal Cancer

作　　者：周瑾 宫希军[1] 吴宗山 彭传勇 ZHOU Jin;GONG Xijun;WU Zongshan;PENG Chuanyong(Department of Medical Imaging,the Second Affiliated Hospital of Anhui Medical University,Anhui 230000,China;Department of Medical Imaging,Lu'an Hospital Affiliated to Anhui Medical University,Anhui 237000,China)

机构地区：[1]安徽医科大学第二附属医院放射科,安徽230000 [2]安徽医科大学附属六安医院医学影像科,安徽237000

出　　处：《影像技术》2024年第6期53-59,80,共8页Image Technology

摘　　要：目的:研究旨在评估3.0T高分辨率磁共振(MRI)的T2WI序列联合DWI序列在直肠癌术前分期中的应用价值,特别是其在TN分期、环周切缘评估、壁外血管受侵及淋巴结转移诊断中的准确性。方法:通过对107例经术后病理证实为直肠癌患者的术前MR影像资料进行回顾性分析,详细观察肿瘤局部浸润和肠系膜淋巴结转移情况。综合运用多种MRI序列和成像方位进行影像学TN分期评估,并与术后病理结果进行对比分析。结果:术前T分期的总准确率为89.7%,与术后病理结果的Kappa值为0.778,显示出良好的一致性。在环周切缘评估中,术前MRI判断为阳性的有53例,而术后病理联合MRI回溯性诊断为阳性的有51例,存在6例误诊。对于直肠壁外血管受侵的判断,术前判断为29例,术后病理确诊为33例,准确率为87.9%。当结合特定的淋巴结影像表现(短径≥5 mm、形态不规则伴边缘毛糙、内部结构不清伴信号不均匀)时,敏感度和特异度相对提高,误诊率和漏诊率降低,与病理结果的一致性最佳,且差异具有统计学意义(P<0.05)。淋巴结N分期的总准确率为86%,与术后病理的Kappa值为0.752,表明一致性良好。结论:3.0T高分辨率MRI通过综合运用T2WI和DWI序列以及多种成像方位,在直肠癌术前分期中显示出较高的准确性,特别是在评估局部侵犯程度和肠周淋巴结转移方面。这为临床医生制定个体化治疗方案提供了有力的影像学支持,为未来进一步探索和优化MRI在直肠癌诊断中的应用提供了有价值的参考。Objective:The objective of this study was to assess the utility of 3.0T high-resolution magnetic resonance imaging(MRI)T2-weighted imaging combined with diffusion-weighted imaging in preoperative staging of rectal cancer,particularly in terms of accuracy for TN staging,evaluation of circumferential resection margin,diagnosis of extramural vascular invasion and lymph node metastasis.Methods:The preoperative MRI data of 107 patients with rectal cancer,confirmed by postoperative pathology,were retrospectively analyzed to provide a detailed assessment of local tumor invasion and mesenteric lymph node metastasis.The imaging TN staging was assessed using a diverse range of MRI sequences and imaging orientations,with subsequent comparison to postoperative pathological findings.Results:The preoperative T stage demonstrated a total accuracy of 89.7%,with a Kappa value of 0.778 for postoperative pathological results,indicating excellent consistency.In the assessment of circumferential resection margin,preoperative MRI identified 53 positive cases,while postoperative pathology combined with retrospective MRI identified 51 positive cases,resulting in six misdiagnoses.Extramural vascular invasion was diagnosed in 29 cases preoperatively and confirmed by postoperative pathology in 33 cases,achieving an accuracy rate of 87.9%.When specific lymph node imaging manifestations were considered(short diameter≥5mm,irregular shape with coarse edge,unclear internal structure with uneven signal),sensitivity and specificity increased while the rates of misdiagnosis and missed diagnosis decreased significantly(P<0.05).Overall accuracy for lymph node N stage was found to be 86%,with a Kappa value of postoperative pathology at 0.752,demonstrating good consistency.Conclusion:The preoperative staging of rectal cancer can be accurately achieved using 3.0T high-resolution MRI,which incorporates T2WI and DWI sequences along with various imaging orientations.This technique particularly excels in evaluating local invasion and perianal lymph node

关 键 词：直肠癌 磁共振成像 高分辨率 肿瘤分期 淋巴结转移 

分 类 号：R73[医药卫生—肿瘤]