中国普外基础与临床杂志

中国普外基础与临床杂志

MRI 影像特征与肿瘤距离测量在直肠癌术前评估中的应用

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目的 总结 MRI 检查在直肠癌术前评估中的应用。 方法 结合文献,阐述直肠癌的 MRI 影像分期,壁外血管侵犯和环周切缘累的 MRI 影像特征,以及肿瘤远端边缘距肛管直肠环/肛缘的测量。 结果 在 T2WI 序列图像中,T1 期表现为等信号肿瘤组织取代正常黏膜下层,未侵及固有肌层;T2 期表现为固有肌层内见肿瘤信号,但肿瘤没有侵及高信号的直肠系膜脂肪;T3 期表现为肿瘤突破固有肌层,侵犯高信号的直肠系膜脂肪;T4 期表现为肿瘤侵犯邻近结构或器官。转移淋巴结表现为边界不规则,在 T2WI 序列图像中呈混杂信号。在 T1WI 序列图像上,直肠壁外血管内可见肿瘤信号,并伴有血管不规则迂曲和扩张。在 T2WI 序列图像上,存在转移淋巴结、壁外血管侵犯及残留肿瘤距低信号直肠系膜筋膜在 1 mm 以内者,预示环周切缘阳性。在 T2WI 序列图像上,高信号的黏膜下层与等信号肿瘤连接处为肿瘤远端边缘,等信号耻骨直肠肌顶端为肛管直肠环的顶点,等信号外括约肌皮下部的最低点为肛缘。 结论 MRI 检查可为直肠癌的术前分期、肿瘤高度的测量及判断预后提供可靠的影像学信息,有助于直肠癌的早期诊治。

Objective To investigate the application of magnetic resonance imaging (MRI) in preoperative assessment of rectal cancer. Methods Combined with the literatures, the MRI features and measurements of rectal tumor staging, extramural vascular invasion, circumferential margin involvement, and the distance between distal margin of the tumor from the anorectal ring and the anal margin were described. Results On T2-weighted images (T2WI), T1 staging-tumors were those in which the normal submucosa was replaced by the iso-intensity of tumor tissue without invasion of muscularis propria; T2 staging-tumors were those with extension into the muscularis propria, but not invaded the high-intensity of mesorectal fat; T3 staging-tumors manifested as the rectal tumor penetrated into the muscularis propria and invaded the high-intensity of mesorectal fat; T4 staging-tumors manifested as the tumor invaded adjacent structures or organs. The metastatic lymph nodes were showed with irregular boundaries and mixed signals on T2WI. The tumor signals could be found in the extramural vascular on T1-weighted images (T1WI), accompanied by irregular distortion and expansion of the blood vessels. On T2WI, metastatic lymph nodes, extramural vascular invasion, and the distance between the residual tumor and the low-signal of mesorectal fascia was within 1 mm, indicated the positive circumferential margin. On T2WI, the distal margin of the tumor was located at the junction of hyperintense submucosa and iso-signal of tumor, the tip of the iso-signal puborectal muscle was the apex of the anorectal ring, and the lowest point of the iso-signal external sphincter was the anal margin. Conclusion MRI can provide reliable imaging information for preoperative staging, height measurement, and prognosis of rectal cancer, and it is helpful for early diagnosis and treatment of rectal cancer.

关键词: 直肠癌; MRI; 影像学诊断; 肿瘤测量; 综述

Key words: rectal cancer; magnetic resonance imaging; imaging diagnosis; tumor measurement; review

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