直肠系膜筋膜MRI薄层检查对直肠癌邻近浸润的临床价值分析
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摘要
目的探讨直肠系膜筋膜MRI薄层检查对直肠癌邻近浸润的临床价值。方法选取2014年10月—2018年2月我院收治的直肠癌患者35例,准确测量直肠癌的位置及范围,并观察直肠癌及其周围结构的MR I表现规律,显示直肠癌、直肠系膜筋膜内淋巴结与环周切缘的关系,并测量肿块、淋巴结与环周切缘的距离,进一步评估直肠癌局部浸润深度及范围。结果 MRI诊断T_1期7例、T_2期11例、T_3期11例、T_4期6例,与病理结果的6例、9例、13例、7例一致性较高。直肠系膜筋膜MR I薄层扫描在诊断直肠癌时,判断病变位置、范围以及局部浸润深度及范围接近手术病理结果(P>0.05)。结论应用直肠系膜筋膜MRI薄层检查能够提高临床诊断准确率和直肠癌的局部浸润和局部分期,对手术边缘有无累及情况进行判断,清晰显示病灶以及邻近浸润状况,为临床治疗提供可靠的依据,应当进一步推广应用。
Objective To evaluate the clinical value of thin layer MRI examination of mesorectal fascia in the infiltration of rectal cancer. Methods From october 2014 to February 2018,35 patients with rectal cancer were selected.The location and range of rectal cancer were accurately measured. The MRI findings of rectal cancer and its surrounding structures were observed. The relationship between rectal cancer,mesorectal intrafascial lymph node and circumferential margin was revealed. The distance between tumor,lymph node and circumferential margin was measured. The depth and extent of local invasion of rectal cancer were further evaluated. Results MRI diagnosis of stage T_1 in 7 cases,stage T_2 in 11 cases,stage T_3 in 11 cases,stage T_4 in 6 cases,and pathological results of 6 cases,9 cases,13 cases,7 cases of high consistency. Thin-slice MRI of mesorectal fascia can accurately determine the location,extent,depth and extent of local infiltration in the diagnosis of rectal cancer,which is close to the results of surgery and pathology(P> 0.05). Conclusion The application of thin-layer MRI of mesorectal fascia can improve the accuracy of clinical diagnosis,local invasion and staging of rectal cancer,judge whether the surgical margin is involved or not,clearly show the lesions and adjacent infiltration,and provide reliable basis for clinical treatment. It should be further promoted and applied.
Objective To evaluate the clinical value of thin layer MRI examination of mesorectal fascia in the infiltration of rectal cancer. Methods From october 2014 to February 2018,35 patients with rectal cancer were selected.The location and range of rectal cancer were accurately measured. The MRI findings of rectal cancer and its surrounding structures were observed. The relationship between rectal cancer,mesorectal intrafascial lymph node and circumferential margin was revealed. The distance between tumor,lymph node and circumferential margin was measured. The depth and extent of local invasion of rectal cancer were further evaluated. Results MRI diagnosis of stage T_1 in 7 cases,stage T_2 in 11 cases,stage T_3 in 11 cases,stage T_4 in 6 cases,and pathological results of 6 cases,9 cases,13 cases,7 cases of high consistency. Thin-slice MRI of mesorectal fascia can accurately determine the location,extent,depth and extent of local infiltration in the diagnosis of rectal cancer,which is close to the results of surgery and pathology(P> 0.05). Conclusion The application of thin-layer MRI of mesorectal fascia can improve the accuracy of clinical diagnosis,local invasion and staging of rectal cancer,judge whether the surgical margin is involved or not,clearly show the lesions and adjacent infiltration,and provide reliable basis for clinical treatment. It should be further promoted and applied.
引文
[1]李静,刘绍伟,殷长俊.小视野、薄层T2WI的直肠癌术前表现与病理结果的对比研究[J].医学影像学杂志,2017,27(11):2176-2179.
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[8]谢海艇,陈明,周鑫,等.MRI评估直肠壁外静脉浸润对预测局部进展期直肠癌术前放化疗敏感性的价值[J].中华普通外科杂志,2016,31(3):193-196.
[9]姚旬,宋幸鹤,王屹.3.0T高分辨磁共振成像对直肠癌浸润深度的诊断价值[J].中华胃肠外科杂志,2016,19(6):668-674.
[10]曹伟,荣耀,刘洪.CT与MRI对直肠癌术前诊断与分期的临床价值对比[J].实用癌症杂志,2016,31(11):1851-1853.
[11]程蓉,窦卫涛.MRI DWI及DCE-MRI综合使用对直肠癌临床分期与诊断价值[J].医学影像学杂志,2016,26(10):1851-1854.
[12]李正军,陈井亚,祝新.直肠腔内置入水囊后MRI检查对直肠癌术前分期的诊断价值[J].中国CT和MRI杂志,2017,15(2):102-104.
[2]卫佳佳,姬丽娟.核磁共振(MRI)和CT评估直肠癌术前T分期的临床价值[J].中国CT和MRI杂志,2017,15(12):113-116.
[3]文露,侯静,卢强,等.MR IVIM-DWI及DCE-MRI对直肠癌系膜淋巴结良恶性的诊断价值[J].实用放射学杂志,2017,33(2):221-225.
[4]宋幸鹤,杨素行,王屹.高分辨率MRI检查诊断直肠癌淋巴结转移及分期的准确性[J].中华消化外科杂志,2017,16(8):865-873.
[5]马小梅,黄刚,和建伟,等.DCE-MRI对直肠癌淋巴结转移评价的病理对照分析[J].临床放射学杂志,2018,3(1):94-99.
[6]杨解宇,王杰,吕兴隆,等.高分辨MRI双重造影结合DWI对直肠癌术前分期的研究[J].CT理论与应用研究,2017,26(2):195-202.
[7]池畔,王枭杰,官国先,等.全直肠系膜切除术中直肠系膜分离终点线的发现和解剖及其临床意义[J].中华胃肠外科杂志,2017,20(10):183-186.
[8]谢海艇,陈明,周鑫,等.MRI评估直肠壁外静脉浸润对预测局部进展期直肠癌术前放化疗敏感性的价值[J].中华普通外科杂志,2016,31(3):193-196.
[9]姚旬,宋幸鹤,王屹.3.0T高分辨磁共振成像对直肠癌浸润深度的诊断价值[J].中华胃肠外科杂志,2016,19(6):668-674.
[10]曹伟,荣耀,刘洪.CT与MRI对直肠癌术前诊断与分期的临床价值对比[J].实用癌症杂志,2016,31(11):1851-1853.
[11]程蓉,窦卫涛.MRI DWI及DCE-MRI综合使用对直肠癌临床分期与诊断价值[J].医学影像学杂志,2016,26(10):1851-1854.
[12]李正军,陈井亚,祝新.直肠腔内置入水囊后MRI检查对直肠癌术前分期的诊断价值[J].中国CT和MRI杂志,2017,15(2):102-104.