Value of high-resolution MRI for assessing preoperative staging and lymph node metastasis in rectal cancer
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摘要:
目的 探究高分辨MRI (HR-MRI)对于直肠癌术前分期以及淋巴结转移的评估价值。 方法 回顾性选取2020年4月~2021年7月在本院接受手术治疗的直肠癌患者60例，收集其术前HR-MRI检查影像资料以及术中样本病理检测结果，对比HR-MRI检测、手术病理检测结果。 结果 60例直肠癌手术病理检测显示，T1~2期、T3期、T4期肿瘤患者分别有患者20例、32例、8例，术前HR-MRI检测结果为17例、38例、5例，两者差异无统计学意义(HC=0.012，P=0.914)。HR-MRI诊断T1~2期的敏感度/特异性分别为85.00%、100.00%，检测T3期肿瘤的敏感度/特异性分别为93.75%、71.43%，T4期分别为62.50%、96.15%，3种分期的敏感度、特异性差异无统计学意义(特异性：χ2=0.302、P=0.289；敏感度：χ2=0.408、P=0.378)。病理检测显示，60例直肠癌患者病理、HR-MRI检测同时存在的淋巴结有289枚，病理检测有129枚淋巴结呈转移阳性，占比44.64%，转移阴性160枚(55.36%)。HRMRI诊断淋巴结转移阳性113枚(39.10%)、淋巴结转移阴性176枚(60.90%)，HR-MRI诊断淋巴结是否发生转移的特异性/敏感度为72.87%、88.13%，诊断符合率为81.31%。 结论 HR-MRI可精确诊断评估直肠癌术前分期、淋巴结转移情况，与手术病理检测结果相似，可为临床制定直肠癌手术方式提供可靠依据，值得临床重视。 Abstract:Objective To explore the value of high-resolution MRI (HR-MRI) in evaluating preoperative stage and lymph node metastasis of rectal cancer. Methods We retrospectively reviewed 60 patients with rectal cancer who underwent surgery in our hospital from April 2020 and July 2021, and their preoperative HR-MRI data and intraoperative sample pathological test results were collected to compare HR-MRI test and surgical pathological test results. Results The surgical pathological results showed 20, 32 and 8 patients with stage T1-2, T3 and T4, respectively, and the Preoperative HR-MRI findings showed 17, 38 and 5 patients, respectively with no significant difference (HC=0.012, P=0.914).The sensitivity/specificity of HR-MRI was 85.00% and 100.00% for the diagnosis of stage T1-2, 93.75% and 71.43% for the detection of stage T3 tumours, and 62.50% and 96.15% for stage T4, respectively, with no statistically significant differences in sensitivity and specificity between the three stages (specificity: χ2=0.302, P=0.289; sensitivity: χ2=0.408, P=0.378). Surgery and pathological examination showed that there were 289 lymph nodes were simultaneously present in 60 rectal cancer patients by pathology and HR-MRI, 129 (44.64%) lymph nodes were positive and 160 (55.36%) were negative for metastasis in pathological examination. 113 (39.10%) lymph nodes were positive for metastasis and 176 (60.90%) were negative for metastasis. The specificity and sensitivity of HR-MRI in diagnosing whether lymph nodes had metastasis were 72.87% and 88.13%. The diagnostic coincidence rate was 81.31%. Conclusion HR-MRI can accurately diagnose and evaluate the preoperative stage and lymph node metastasis of rectal cancer, and the results are similar to surgical pathological results. It can provide a reliable basis for clinical planning of rectal cancer surgery and deserve clinical attention. -
Key words:
- rectal cancer /
- high-resolution MRI /
- staging /
- lymph node /
- evaluation value
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图 1 直肠癌患者术前HR-MRI影像
A~B: 淋巴结HR-MRI影像（A: 阴性患者; B: 阳性患者）；C~F：不同T分期直肠癌患者HR-MRI影像（C: T1~ 2期; D: T2期; E: T3期; F: T4期）.
Figure 1. HR-MRI images of rectal cancer patients before operation
表 1 两种诊断方式直肠癌分期结果对比
Table 1. Comparison of staging results of rectal cancer by the two methods (n)
诊断方式 T1~2 T3 T4 HR-MRI 17 38 5 手术病理 20 32 8 Hc 0.012 P 0.914 
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表 2 HR-MRI评估直肠癌分期情况
Table 2. Evaluation of rectal cancer staging with HR-MRI
HR-MRI 手术病理(n) 合计(n) 特异性(%) 敏感度(%) 诊断符合率(%) 阳性 阴性 T1~2 阳性 17 0 17 阴性 3 40 43 85.00(17/20) 100.00(40/40) 95.00(57/60) 总计 20 40 60 T3 阳性 30 8 38 阴性 2 20 22 93.75(30/32) 71.43(20/28) 83.33(50/60) 总计 32 28 60 T4 阳性 5 0 5 阴性 3 50 55 62.50(5/8) 96.15(50/52) 91.67(55/60) 总计 8 52 60 χ2 0.302 0.408 4.810 P 0.289 0.378 0.090
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表 3 HR-MRI评估直肠癌淋巴转移情况
Table 3. Evaluation of lymphatic metastasis of rectal cancer with HR-MRI
HR-MRI 手术病理(n) 合计(n) 特异性(%) 敏感度(%) 诊断符合率(%) 淋巴结转移阳性 淋巴结转移阴性 淋巴结转移阳性 94 19 113 72.87(94/129) 88.13(141/160) 81.3(235/289) 淋巴结转移阴性 35 141 176 合计 129 160 289
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[1] Benson AB, Venook AP, Al-Hawary MM, et al. Rectal cancer, version 2.2018, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2018, 16(7): 874-901. doi: 10.6004/jnccn.2018.0061 [2] 高晶晶, 李绍东, 李江山, 等. PET/CT-MRI三模式在直肠癌局部分期中的应用[J]. 中国医学计算机成像杂志, 2017, 23(2): 185-90. doi: 10.3969/j.issn.1006-5741.2017.02.016 [3] Mullaney TG, Lightner AL, Johnston M, et al. 'Watch and wait'after chemoradiotherapy for rectal cancer[J]. ANZ J Surg, 2018, 88(9): 836-41. doi: 10.1111/ans.14352 [4] 许蕾, 邵瑞, 李红蕾, 等. 基于MRI多参数联合对T3期直肠癌亚分期的诊断价值[J]. 放射学实践, 2020, 35(4): 514-8. https://www.cnki.com.cn/Article/CJFDTOTAL-FSXS202004027.htm [5] 周云朋, 李硕, 张宪祥, 等. 基于深度神经网络的高分辨MRI直肠淋巴结辅助诊断系统的临床应用价值研究[J]. 中华外科杂志, 2019, 57 (2): 108-13. https://cdmd.cnki.com.cn/Article/CDMD-11065-1019670134.htm [6] 刘朵朵, 侯炜寰, 齐顺, 等. 3.0T MRI在直肠癌术前评估中的应用研究[J]. 实用放射学杂志, 2017, 33(4): 537-41. doi: 10.3969/j.issn.1002-1671.2017.04.013 [7] Compton CC, Greene FL. The staging of colorectal cancer: 2004 and beyond[J]. CA Cancer J Clin, 2004, 54(6): 295-308. doi: 10.3322/canjclin.54.6.295 [8] 万幸, 赵心竹, 罗敏, 等. 结直肠癌双层探测器光谱CT成像: 转移性与非转移性淋巴结的对照研究[J]. 放射学实践, 2021, 36(12): 1543-7. https://www.cnki.com.cn/Article/CJFDTOTAL-FSXS202112016.htm [9] 徐恩盼, 李冰, 周平红, 等. 内镜黏膜下剥离术治疗超高龄患者结直肠癌前病变及早期癌的临床疗效分析[J]. 中华消化内镜杂志, 2021, 38 (12): 985-90. doi: 10.3760/cma.j.cn321463-20201207-00616 [10] Bahadoer RR, Dijkstra EA, van Etten B, et al. Short-course radiotherapy followed by chemotherapy before total mesorectal excision (TME) versus preoperative chemoradiotherapy, TME, and optional adjuvant chemotherapy in locally advanced rectal cancer (RAPIDO): a randomised, open-label, phase 3 trial[J]. Lancet Oncol, 2021, 22(1): 29-42. doi: 10.1016/S1470-2045(20)30555-6 [11] 陈邦飞, 杨超颖, 金纯, 等. 高分辨MRI评估对低位直肠癌保肛手术中的意义及其疗效的影响[J]. 中华普通外科杂志, 2020, 35(8): 616-9. doi: 10.3760/cma.j.cn113855-20200321-00230 [12] Dieguez A. Rectal cancer staging: focus on the prognostic significance of the findings described by high-resolution magnetic resonance imaging[J]. Cancer Imaging, 2013, 13(2): 277-97. doi: 10.1102/1470-7330.2013.0028 [13] 闫咪, 杨青, 范萍萍, 等. 高分辨MRI在直肠癌TN分期及手术方式选择中的应用[J]. 中国医学影像技术, 2017, 33(S1): 50-4. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYXX2017S1021.htm [14] 王玉娟, 陈勇, 吕茜婷, 等. 3.0T磁共振成像术前诊断直肠癌壁外脉管侵犯的价值及相关因素[J]. 中华肿瘤杂志, 2019, 41(8): 610-4. [15] Uberoi AS, Bhutani MS. Has the role of EUS in rectal cancer staging changed in the last decade?[J]. Endosc Ultrasound, 2018, 7 (6): 366-70. doi: 10.4103/eus.eus_36_18 [16] Lei J, Wang HY. Application of magnetic resonance imaging in TN re-staging and efficacy evaluation after neoadjuvant therapy for rectal cancer[J]. Zhonghua Wei Chang Wai Ke Za Zhi, 2018, 21(6): 637-41. [17] 戴鑫, 徐青, 余静, 等. MRI在评估直肠癌局部淋巴结转移中的应用价值[J]. 中国临床医学影像杂志, 2017, 28(2): 112-5. doi: 10.3969/j.issn.1008-1062.2017.02.010 [18] 姜相森, 阴祖栋, 张新毅, 等. T2WI与DWI在直肠癌淋巴结转移评估中的应用[J]. 山东医药, 2019, 59(23): 70-3. doi: 10.3969/j.issn.1002-266X.2019.23.016 [19] 李杰, 李晓燕, 常远, 等. 无淋巴结转移的直肠癌患者发生远处转移的危险因素分析[J]. 中华实验外科杂志, 2021, 38(10): 2038-9. doi: 10.3760/cma.j.cn421213-20210223-01059 [20] 陈琰, 杨心悦, 卢宝兰, 等. 3.0T高分辨MRI诊断直肠癌直肠系膜淋巴结转移的应用价值[J]. 中华胃肠外科杂志, 2018, 21(7): 786-92. doi: 10.3760/cma.j.issn.1671-0274.2018.07.013 [21] 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): 865-73. doi: 10.3760/cma.j.issn.1673-9752.2017.08.021 -
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