直肠癌MRI和临床.pptx

直肠癌MRI和临床;直肠为大肠的末段，长约15-16cm，位于小骨盆内。上端平第3骶椎处接续乙状结肠，沿骶骨和尾骨的前面下行，穿过盆膈，下端以肛门而终。;外科学上，将由盆筋膜脏层包绕的直肠周围脂肪结缔组织、血管、神经和淋巴组织统称之为直肠系膜（mesorectum）。 直肠癌环周切缘（circum ferential resection Margin ，CRM）是一个外科学概念，是指围绕直肠系膜的盆腔脏层筋膜，即直肠系膜筋膜（mesoretal fascia，MRF）。;来源：中国临床解剖学杂志2005年第23卷第4期;图2 盆腔标本解剖前的 MRI(T1WI) 箭头示直肠系膜筋膜为均匀的低信号线；三角示直肠系膜则为均匀高信号。;Denonviller‘s Fascia（DVF，邓氏筋膜）;Rectal Cancer - MR staging 2.0Rhiannon van Loenhout, Frank Zijta, Max Lahaye, Regina Beets-Tan and Robin Smithuis Radiology Departement of the Medical Centre Haaglanden in the Hague,The Netherlands Cancer Institute in Amsterdam and the Alrijne Hospital in Leiderdorp, the Netherlands;Introduction Total mesorectal excision TNM-stage MR protocol DWI Location of the tumor Low rectal cancer T-stage T1 and T2 T3 T3 with MRF involvement T4a - Invasion peritoneal reflection T4b - Invasion surrounding organs Extramural vascular invasion (EMVI) N-stage Extramesorectal lymph nodes Regional Lymph nodes ;The mesorectal fascia (MRF) plays a crucial role in the treatment plannnig. In TME the mesorectal fascia is the resection plane and it has to be tumor-free.A distance of the tumor to the mesorectal fascia of ?1 mm is regarded as not suitable for TME and is called an involved MRF. This means that the tumor has to be downstaged before TME is possible. On MRI the mesorectal fat has high signal intensity on both T1- and T2-weighted images.The mesorectal fat is surrounded by the mesorectal fascia, which is seen as a fine line of low signal intensity (arrows).High resolution T2-images are needed to clearly identify the MRF (7).;The MRF is only circumferential in the low-rectum below the anterior peritoneal reflection (see next illustration). The MRF does not apply to the anterior peritonealized surface of the anterior mid- and high rectum.;The treatment of a patient with rectal cancer depends on the TNM-stage and whether the MRF is involved. T-staging T1 and T2 tumors are limited to the bowel wall.T3 tumors grow thr