MRI对直肠癌术前T分期及环周切缘判断的应用价值.docVIP

MRI对直肠癌术前T分期及环周切缘判断的应用价值 刘骏1 ,唐一帆1,,汤伟军2 基金项目:上海市卫生局科研课题资助项目(2009011) 通讯作者:唐一帆 tangyifan618@126.com 200040 复旦大学附属华山医院 普外科1 放射科2 【摘要】 目的：探讨MRI对直肠癌术前T分期及环周切缘判断的临床应用价值。 方法：选取复旦大学附属华山医院2010 年3 月至2011 年12 月期间88例活检组织病理学证实的直肠癌患者, 术前行MRI分期。检查后7天内, 按照全直肠系膜切除原则行直肠癌切除手术。最终将影像资料与术后病理结果对照分析。结果：MRI对T分期的总体准确度达到86.4%（76/88），对T2期肿瘤诊断的灵敏度为68.4%（13/19），特异度为92.8%（64/69），对T3期肿瘤诊断的灵敏度为93.8%（60/64），特异度为70.8%（17/24）。MRI对环周切缘的准确度达到92.1%（81/88），灵敏度为83.3%（10/12），特异度为93.4%（71/76）。结论：MRI对直肠癌术前T分期及环周切缘的判断有高度的准确率，对直肠癌患者选择合理的治疗方案有极高的应用价值。 【关键词】 直肠癌 MRI T分期 环周切缘 Role of Magnetic Resonance Imaging in T Staging and Circumferential Resection Margin of Rectal Cancer LIU Jun1,TANG Yifan1,TANG Weijun2. Department of General Surgery1, Department of Radiology2, Huashan Hospital, Fudan University, Shanghai 200040, China 【Abstract】Objective To assess the value of magnectic resnonance imaging in p redicting T stage and resection margin involvement of primary rectal cancer before operation. Methods Between March 2010 and December 2009,88 patients with histologically proven rectal cancer by the biopsy in Huashan Hospital were staged preoperatively using MRI . All patients underwent total mesorectual excision (TME) operation within 1 week after MRI examination.The results of preoperative MRI were analyzed and compared with that of histopathology. Results The accuracy rate of MRI was 86.4%(76/88) for T staging in total，The MRI sensitivity and specificity was 68.4%(13/19) and 92.8%(64/69) for T2 stage tumors,93.8%(60/64) and 70.8%(17/24) for T3 stage tumors.The accuracy rate,sensitivity and specificity of MRI for assessment of CRM,was 92.1%(81/88),83.3%(10/12) and 93.4%(71/76). Conclusion MRI can accurately predicate T staging and CRM of rectal cancer preoperatively, it can help to provide valuable information for the choice of treatment. 【key words】 rectal cancer MRI T stage CRM 直肠癌是常见的恶性肿瘤,外科手术仍是直肠癌治疗最主要的方法。术后的局部复发成为了影响患者生存率的重要因素，过去直肠癌的局部复发率高达32%[1]，随着全直肠系膜切除（Total Mesorectal Excis