高分辨T_2WI对直肠癌局部侵犯的术前评价
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摘要
目的探讨高分辨T2WI在直肠癌局部侵犯术前评价的应用价值。方法 49例临床确诊为直肠癌且未接受放化疗并拟手术切除的患者术前行包括横断位高分辨T2WI和常规T2WI的MRI检查,由两位医师依据横断位高分辨T2WI和常规T2WI对肿瘤局部侵犯进行术前评价,其中37例手术切除患者入选本研究。以手术病理分期为标准,评价高分辨T2WI和常规T2WI对直肠癌局部分期判断的准确性。结果依据高分辨T2WI和常规T2WI读片医师1对直肠癌局部分期术前正确指示率分别为89.2%和62.2%,读片医师2为83.8%和59.5%。两位医师读片结果差异均有统计学意义(P值分别为0.03和0.01)。两位读片医师依据高分辨T2WI和常规T2WI对直肠癌局部侵犯评价一致性检验结果分别为0.77和0.60。结论与常规T2WI比较,高分辨T2WI能提高MRI对直肠癌局部分期术前评价的准确性,应作为直肠癌MRI检查的常规扫描序列。
Objective To evaluate high-resolution T2 weighted imaging in preoperatively judging local invasion of rectal cancer. Methods A total of 49 patients with pathologically-proved rectal cancer,who had not received chemotherapy or radiotherapy and were planed to receive surgery,underwent MRI scanning,including high resolution T2 weighted and conventional T2 weighted sequences. T2 weighted and conventional T2 weighted images were independently evaluated by two radiologists for preoperative assessment of local invasion of the primary tumors. Thirty-seven patients receiving surgical resection of the tumor were enrolled in this study. Taking surgical and histopathological staging as standard reference,the staging accuracy of rectal cancer by high resolution T2 WI and conventional T2 WI was determined by using McNemar test. Results The diagnostic results of doctor A showed that the preoperative correct prediction for T-stage by high resolution T2WI( 89.2%) was significantly higher than that by conventional T2WI( 62. 2%),which were 83. 8% and 59. 5% respectively by doctor B. The difference was statistically significant( P = 0. 03 and P = 0. 01 respectively). The diagnostic consistency between the two doctors by high resolution T2 WI and conventional T2 WI was 0. 77 and 0. 60 respectively. Conclusion Compared with conventional T2 weighted images,high resolution T2 weighted images can improve the preoperative prediction accuracy for rectal cancer T-staging. It is recommended to routinely use high resolution T2 weighted images for the staging of rectal cancer.
Objective To evaluate high-resolution T2 weighted imaging in preoperatively judging local invasion of rectal cancer. Methods A total of 49 patients with pathologically-proved rectal cancer,who had not received chemotherapy or radiotherapy and were planed to receive surgery,underwent MRI scanning,including high resolution T2 weighted and conventional T2 weighted sequences. T2 weighted and conventional T2 weighted images were independently evaluated by two radiologists for preoperative assessment of local invasion of the primary tumors. Thirty-seven patients receiving surgical resection of the tumor were enrolled in this study. Taking surgical and histopathological staging as standard reference,the staging accuracy of rectal cancer by high resolution T2 WI and conventional T2 WI was determined by using McNemar test. Results The diagnostic results of doctor A showed that the preoperative correct prediction for T-stage by high resolution T2WI( 89.2%) was significantly higher than that by conventional T2WI( 62. 2%),which were 83. 8% and 59. 5% respectively by doctor B. The difference was statistically significant( P = 0. 03 and P = 0. 01 respectively). The diagnostic consistency between the two doctors by high resolution T2 WI and conventional T2 WI was 0. 77 and 0. 60 respectively. Conclusion Compared with conventional T2 weighted images,high resolution T2 weighted images can improve the preoperative prediction accuracy for rectal cancer T-staging. It is recommended to routinely use high resolution T2 weighted images for the staging of rectal cancer.
引文
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14 Rao SX,Zeng MS,Chen CZ,et al.The value of diffusion-weighted imaging in combination with T2-weighted imaging for rectal cancer detection.Eur J Radiol,2008,65:299
15 Koh DM,Collins DJ.Diffusion-weighted MRI in the body:applications and challenges in oncology.AJR,2007,188:1622
16 Nasu K,Kuroki Y,Kuroki S,et al.Diffusion-weighted single shot echo planar imaging of colorectal cancer using a sensitivity-encoding technique.Jpn J Clin Oncol,2004,34:620
17 Park MJ,Kim SH,Lee SJ,et al.Locally advanced rectal cancer:added value of diffusion-weighted MR imaging for predicting tumor clearance of the mesorectal fascia after neoadjuvant chemotherapy and radiation therapy.Radiology,2011,260:771
18 Kim SH,Lee JM,Hong SH,et al.Locally advanced rectal cancer:added value of diffusion-weighted MR imaging in the evaluation of tumor response to neoadjuvant chemo-and radiation therapy.Radiology,2009,253:116
2 Baek SJ,Kim SH,Kwak JM,et al.Selective use of preoperative chemoradiotherapy for T3 rectal cancer can be justified:analysis of local recurrence.World J Surg,2013,37:220
3 Zorcolo L,Rosman AS,Restivo A,et al.Complete pathologic response after combined modality treatment for rectal cancer and longterm survival:a meta-analysis.Ann Surg Oncol,2012,19:2822
4 Dewhurst CE,Mortele KJ.Magnetic resonance imaging of rectal cancer.Radiol Clin North Am,2013,51:121
5 Group MS.Diagnostic accuracy of preoperative magnetic resonance imaging in predicting curative resection of rectal cancer:prospective observational study.BMJ,2006,333:779
6 Group MS.Extramural depth of tumor invasion at thin-section MR in patients with rectal cancer:results of the MERCURY study.Radiology,2007,243:132
7 Gollub MJ,Maas M,Weiser M,et al.Recognition of the anterior peritoneal reflection at rectal MRI.AJR,2013,200:97
8 Stollfuss JC,Becker K,Sendler A,et al.Rectal carcinoma:high-spatial-resolution MR imaging and T2 quantification in rectal cancer specimens.Radiology,2006,241:132
9 Rollvén E,Holm T,Glimelius B,et al.Potentials of high resolution magnetic resonance imaging versus computed tomography for preoperative local staging of colon cancer.Acta Radiol,2013,54:722
10 Kaur H,Choi H,You YN,et al.MR imaging for preoperative evaluation of primary rectal cancer:practical considerations.RadioGraphics,2012,32:389
11 Nougaret S,Reinhold C,Mikhael HW,et al.The use of MR imaging in treatment planning for patients with rectal carcinoma:have you checked the“DISTANCE”Radiology,2013,268:330
12 Heald RJ,Moran BJ,Ryall RD,et al.Rectal cancer:the Basingstoke experience of total mesorectal excision,1978-1997.Arch Surg,1998,133:894
13 MERCURY Study Group.Extramural depth of tumor invasion at thinsection MR in patients with rectal cancer:results of the MERCURY study.Radiology,2007,243:132
14 Rao SX,Zeng MS,Chen CZ,et al.The value of diffusion-weighted imaging in combination with T2-weighted imaging for rectal cancer detection.Eur J Radiol,2008,65:299
15 Koh DM,Collins DJ.Diffusion-weighted MRI in the body:applications and challenges in oncology.AJR,2007,188:1622
16 Nasu K,Kuroki Y,Kuroki S,et al.Diffusion-weighted single shot echo planar imaging of colorectal cancer using a sensitivity-encoding technique.Jpn J Clin Oncol,2004,34:620
17 Park MJ,Kim SH,Lee SJ,et al.Locally advanced rectal cancer:added value of diffusion-weighted MR imaging for predicting tumor clearance of the mesorectal fascia after neoadjuvant chemotherapy and radiation therapy.Radiology,2011,260:771
18 Kim SH,Lee JM,Hong SH,et al.Locally advanced rectal cancer:added value of diffusion-weighted MR imaging in the evaluation of tumor response to neoadjuvant chemo-and radiation therapy.Radiology,2009,253:116