经直肠双平面彩超与磁共振成像在直肠癌术前分期中的应用价值

Comparative study of endorectal ultrasonography and magnetic resonance imaging in preoperative staging of rectal cancer

目的 比较分析经直肠双平面彩超（ERUS）与磁共振成像技术（MRI）在直肠癌术前分期中的应用价值.方法 收集2010年9月至2012年12月北京医院直肠癌住院患者44例病例资料.患者分别行直肠双平面彩超检查与磁共振显像,所有病例均经手术、病理确诊.结果 本资料中,腺癌40例,类癌1例,间质瘤（低度恶性）1例,腺瘤癌变2例.ERUS判断直肠癌浸润肠壁深度uT1、uT2、uT3、uT4的诊断符合率分别为95.5％、90.9％、93.2％、97.7％,总的诊断符合率为88.6％（39/44）,灵敏性分别为83.3％、72.7％、72.2％、77.8％,特异性分别为97.3％、92.9％、96.2％、97.6％;MRI判断直肠癌浸润肠壁深度T1、T2、T3、T4的诊断符合率分别为93.2％、90.9％、93.2％、100.0％,总的诊断符合率为86.4％ （38/44）,灵敏性分别为71.4％、93.8％、94.4％、100.0％,特异性分别为97.3％、89.3％、92.3％、100.0％.ERUS对直肠癌术前分期与MRI比较差异无统计学意义.ERUS对肠周淋巴结转移判断的灵敏性为68.4％ （13/19）、特异性为80.0％（20/25）、诊断符合率为75.0％（33/44）;MRI对肠周淋巴结转移判断的灵敏性为94.7％ （18/19）、特异性为92.0％ （23/25）、诊断符合率为93.2％ （41/44）.结论 经直肠双平面彩超与磁共振同样能对直肠癌的术前准确分期,前者对T1期诊断准确率和敏感性较高,后者对肠周淋巴结转移判断更有优势.

Objective To evaluate the diagnostic value of endorectal ultrasonography （ERUS） and magnetic resonance imaging （MRI） in preoperative staging of rectal carcinoma.Methods A total of 44 patients with biopsy proven rectal tumor underwent preoperative ERUS and MRI examinations.All patients were evaluated to determine the diagnostic accuracy of depth of transmural tumor invasion and lymph node metastases.Imaging results were compared with histopathological findings.Results The accuracy of T staging （uT1,uT2,uT3,uT4） for ERUS was 95.5%,90.9%,93.2% and 97.7% and the overall accuracy 88.6% （39/44）.The sensitivity was 83.3%,72.7%,72.2%,77.8% and the specificity 97.3%,92.9%,96.2% and 97.6%.The accuracy ofT staging （T1,T2,T3,T4） for MRI was 93.2%,90.9%,93.2%,100.0% and the overall accuracy 86.4% （38/44）.The sensitivity was 71.4%,93.8%,94.4% and 100.0% and the specificity 97.3%,89.3%,92.3% and 100.0%.Detection of lymph node metastases：the accuracy of ERUS was 75.0% （33/44）,MRI 93.2% （41/44）.The sensitivity and specificity was found to be 68.4% （13/19） and 80.0% （20/25） on ERUS,94.7% （18/19） and 92.0% （23/25） on MRI respectively.Conclusion ERUS and MRI may be used for accurate preoperative staging of rectal cancer.ERUS has higher accuracy and sensitivity for T1 stage while MRI is preferred for lymph node metastasis.