mri对直肠癌前tn分期评估价值.pdfVIP

MRI 对直肠癌术前TN 分期评估价值 摘 要 目的: 评价磁共振成像常规检查序列和弥散加权序列在直肠癌术前 TN 分期中 的作用。 方法：2005 年1 月至2007 年1 月60 例直肠癌患者进行术前MRI 检查，其中有 37 例加扫扩散加权序列，并与病理结果对照。另对37 例直肠癌患者分别进行MR 扩 散加权序列检查,分别测定瘤体、淋巴结和皮下脂肪ADC 值，比较不同b 值下瘤体 分化级别与ADC 值有无差异,同时比较良恶性淋巴结ADC 值有无差异。 结果：MR 对直肠壁浸润深度敏感性77.8％, 特异性81.8％, 准确性80％，与 病理分期结果一致性中等（Kappa 值为0.596）；N 分期敏感性是85.3％，特异性是 69.2％，准确性是78.3％；与病理分期结果一致性中等（Kappa 值为0.553）；联用 增强序列和单独用 T2WI 对直肠壁浸润深度和淋巴结分期评定无明显差异。同一 b 值下瘤体分化级别组间无差异，良恶性淋巴结ADC 值组间有差异。 结论: MRI 可以较准确评估直肠肿瘤浸润深度和淋巴结转移情况，较准确做出 直肠癌术前TN 分期。增强FSPGR 序列对直肠壁浸润深度和良恶性淋巴结鉴别价值 不大。磁共振扩散加权序列对直肠癌和淋巴结检出是个可行性方法, ADC 值对良恶 性淋巴结鉴别有一定价值，DWI 序列有望成为直肠癌术前分期的常规扫描序列。 关键词:直肠癌，分期，磁共振成像，扩散加权序列，表观扩散系数 EVALUATION OF MAGNETIC RESONANCE IMAGING IN TN-STAGING OF RECTAL CANCER ABSTRACT Objective: To assess the value of magnetic resonance imaging ( MRI )with conventional sequences (spin echo T1WI and T2WI )and diffusion-weighted imaging ( DWI ) sequences in the preoperative staging of rectal cancer. Methods: MR imaging was performed in sixty patients with rectal cancer, among which thirty-seven patients were evaluated with both single-shot echo plannar imaging(EPI) diffusion-weighted sequences and conventional sequences. All these findings were prospectively analyzed in two doctors separately and correlated with the surgery pathological findings. Difference in performance of T2-weighted and combined T2-weighted plus gadolinium-enhanced FSPGR sequences was analyzed by comparing corresponding areas under ROC curves (Az) for each radiologist. The apparent diffusion coefficients (ADCs) of the tumors、lymph nodes and lip in each patient were measured to evaluate the correlation between ADC and pathological classification of each tumor ,including between benign and malignant lymph nodes. Results: Sensitivity of MRI in detecting invasion through the bowel wall was 77.8%, Specific