中国普外基础与临床杂志

中国普外基础与临床杂志

CT 和 MRI 对直肠癌术前 T、N 分期的对比研究

查看全文

目的 比较螺旋 CT 与磁共振成像(MRI)对直肠癌术前 T、N 分期判断的价值。 方法 回顾性分析 2013 年 1 月至 2017 年 1 月期间合肥市第二人民医院普外科收治并行手术治疗的 81 例直肠癌患者的影像学资料,81 例患者均行了 CT 检查,其中 63 例患者同时行了 MRI 检查,以术后病理检查结果为金标准,比较 CT 和 MRI 对判断直肠癌 T 分期和 N 分期的准确性。 结果 CT 和 MRI 判断直肠癌术前 T 分期的灵敏度分别为 69.1%(56/81)和 82.5%(52/63),二者比较差异无统计学意义(χ2=3.396,P=0.065);其 Kappa 值分别为 0.521 和 0.720,提示 CT 判断 T 分期与病理诊断一致性一般而MRI 判断 T 分期与病理诊断一致性较好。CT 判断 T1-2、T3 及 T4 期的灵敏度分别为 70.0%、66.7% 和 72.0%,MRI 判断 T1-2、T3 及 T4 期的灵敏度分别为 83.3%、83.3% 和 81.0%,二者分别比较差异均无统计学意义(P>0.05)。CT 和 MRI 判断 T1-2、T3 和 T4 期的受试者操作特征曲线下面积分别为 0.809、0.689 和 0.798 以及 0.897、0.826 和0.869。CT 和 MRI 判断直肠癌术前 N 分期的灵敏度分别为 59.3%(48/81)和 65.1%(41/63),二者比较差异无统计学意义(χ2=0.509,P=0.476);其 Kappa 值分别为0.371 和 0.463,CT 和 MRI 判断 N 分期与病理诊断一致性均一般。CT 判断 N0、N1 和 N2 期的灵敏度分别为 64.7%、45.5% 和 64.0%,MRI 判断N0、N1 和 N2 期的灵敏度分别为70.3%、63.2% 和 72.5%,二者分别比较差异均无统计学意义(P>0.05)。 结论 MRI 判断直肠癌肿瘤浸润深度优于 CT,二者对淋巴结转移的判断准确度均不高。

Objective To compare diagnosis values of computed tomography (CT) and magnetic resonance imaging (MRI) in preoperative staging of rectal carcinoma. Methods The imaging data of 81 patients with rectal carcinoma from January 2013 to January 2017 in the Hefei Second People’s Hospital were retrospectively analyzed. Based on the postoperative pathological results, the diagnostic accordance rates of CT and MRI on the T staging and N staging were calculated. Results The sensitivities of the CT and MRI on the preoperative T staging of rectal carcinoma were 69.1% (56/81) and 82.5% (52/63), the difference was not statistically significant (χ2=3.396, P=0.065), the Kappa values was 0.521 and 0.371, respectively, the MRI on the T staging was in a good agreement with the pathological diagnosis. The sensitivitie of the T1-2, T3, and T4 stagings with CT was 70.0%, 66.7%, and 72.0%, respectively, with MRI was 83.3%, 83.3%, and 81.0%, respectively, which had no significant difference respectively between the CT and the MRI. The areas under the receiver operating characteristic curve of the T1-2, T3, and T4 stagings with the CT and MRI were 0.809, 0.689, 0.798 and 0.897, 0.826, 0.869, respectively. The sensitivities of the CT and MRI on the preoperative N staging of rectal carcinoma were 59.3% (48/81) and 65.1% (41/63), the difference was not statistically significant (χ2=0.509, P=0.476), the Kappa values were 0.371 and 0.463, respectively. The sensitivities of the N0, N1, N2 stagings with CT were 64.7%, 45.5%, 64.0%, with MRI were 70.3%, 63.2%, 72.5%, which had no significant difference respectively between the CT and the MRI. Conclusions Results of in this study show that MRI is superior to CT for judgment of tumor infiltration. Neither CT nor MRI is able to provide satisfactory assessment of lymph node metastasis.

关键词: 直肠癌; 术前分期; 螺旋 CT; 磁共振成像

Key words: rectal carcinoma; preoperative staging; spiral CT; magnetic resonance imaging

引用本文: 杨仁保, 李良, 张军, 李文波, 鲁俊. CT 和 MRI 对直肠癌术前 T、N 分期的对比研究. 中国普外基础与临床杂志, 2018, 25(4): 433-437. doi: 10.7507/1007-9424.201709021 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Lee DJ, Sagar PM, Sadadcharam G, et al. Advances in surgical management for locally recurrent rectal cancer: How far have we come? World J Gastroenterol, 2017, 23(23): 4170-4180.
2. Engin G, Sharifov R. Magnetic resonance imaging for diagnosis and neoadjuvant treatment evaluation in locally advanced rectal cancer: A pictorial review. World J Clin Oncol, 2017, 8(3): 214-229.
3. Benson AB 3rd, Venook AP, Bekaii-Saab T, et al. Rectal cancer, version 2.2015. J Natl Compr Canc Netw, 2015, 13(6): 719-728.
4. 肖毅. 低位直肠癌的外科治疗选择. 腹部外科, 2014, 27(4): 236-238.
5. Garisto JD, Klotz L. Active surveillance for prostate cancer: how to do it right. Oncology (Williston Park), 2017, 31(5): 333-340.
6. 黄蓉, 张路柠, 肖巍魏, 等. 291 例局部进展期直肠癌术前新辅助放化疗的临床意义分析. 中华放射肿瘤学杂志, 2015, 24(2): 143-148.
7. 彭海花, 王成涛, 余昕, 等. 局部晚期直肠癌术前同期放化疗达 pCR 者预后分析. 中华放射肿瘤学杂志, 2016, 25(10): 1079-1082.
8. Xu D, Ju HX, Qian CW, et al. The value of TRUS in the staging of rectal carcinoma before and after radiotherapy and comparison with the staging postoperative pathology. Clin Radiol, 2014, 69(5): 481-484.
9. 吕东昊, 高强, 汪晓东, 等. 多层螺旋 CT 联合不同炎性反应指标对直肠癌外科决策的随机对照研究. 中国普外基础与临床杂志, 2009, 16(10): 851-855.
10. 田博, 杨得振, 贾勇, 等. CT、MRI 影像诊断对直肠癌临床术前分期价值研究. 中国 CT 和 MRI 杂志, 2015, 13(11): 108-110, 114.
11. 王亚宁, 时高峰, 杜煜. 比较 MSCT 与 MRI 在结直肠癌术前分期诊断中的价值. 中国医学影像技术, 2011, 27(4): 772-775.
12. Shida D, Iinuma G, Komono A, et al. Preoperative T staging using CT colonography with multiplanar reconstruction for very low rectal cancer. BMC Cancer, 2017, 17(1): 764.
13. Nerad E, Lahaye MJ, Maas M, et al. Diagnostic accuracy of CT for local staging of colon cancer: a systematic review and meta-analysis. AJR Am J Roentgenol, 2016, 207(5): 984-995.
14. 曾令延, 魏文洲. 64 层螺旋 CT 仿真内镜在结直肠癌的检测和术前分期中的作用. 医学影像学杂志, 2013, 23(2): 268-270, 274.
15. 鲁家贤, 童铁军, 董孙根, 等. 结直肠癌多层螺旋 CT 浸润征像与病理预后因子的关系. 浙江医学, 2015, 34(6): 469-472.
16. Hellström M, Svensson MH, Lasson A. Extracolonic and incidental findings on CT colonography (virtual colonoscopy). AJR Am J Roentgenol, 2004, 182(3): 631-638.
17. Li XT, Zhang XY, Sun YS, et al. Evaluating rectal tumor staging with magnetic resonance imaging, computed tomography, and endoluminal ultrasound: A meta-analysis. Medicine (Baltimore), 2016, 95(44): e5333.
18. 唐娜, 尚乃舰, 张红霞. 3.0T 高分辨率 MRI 在直肠癌术前 T 分期中的价值. 中国临床医学影像杂志, 2016, 27(8): 562-564, 569.
19. 甘锐, 余文毅. CT、MRI 成像用于直肠癌术前分期诊断中的价值对比研究. 四川医学, 2016, 37(6): 678-680.
20. Nerad E, Lambregts DM, Kersten EL, et al. MRI for local staging of colon cancer: can MRI become the optimal staging modality for patients with colon cancer? Dis Colon Rectum, 2017, 60(4): 385-392.
21. 丛冠宁, 秦明伟, 贺丹, 等. 高分辨率 MRI 对直肠癌 TNM 分期及环周切缘的评估. 中国普外基础与临床杂志, 2010, 17(9): 894-900.
22. Beets-Tan RG, Beets GL, Vliegen RF, et al. Accuracy of magnetic resonance imaging in prediction of tumour-free resection margin in rectal cancer surgery. Lancet, 2001, 357(9255): 497-504.
23. 任镜清, 薛福龙, 刘少杰, 等. 淋巴结转移度及肿瘤 N 分期对Ⅲ期结直肠癌复发或转移的预测价值. 中华胃肠外科杂志, 2015, 18(6): 553-557.