直肠癌患者及健康人群直肠及周围解剖结构的高分辨MRI观察

High resolution magentic resonance imaging observation of the rectum and its surrounding anatomy structures in patients with rectal cancer and normal population and its clinical significance

目的 应用高分辨MRI观察直肠肠壁及其周围解剖细节,为直肠癌的临床诊断和治疗提供解剖参数和依据。 方法 收集60名健康人及20例直肠癌患者的盆腔多序列参数MRI;两位高年资医师行双盲法阅片,对20例直肠癌患者行术前T分期并与术后病理对照,分析准确率;统计分析60名正常人直肠固有筋膜前、后、左、右侧的MRI显示率,以及所有研究对象的骶前筋膜、骶骨筋膜、腹膜返折、直肠侧韧带、下腹下丛的MRI显示率。结果 高分辨MRI可以清楚地显示直肠壁的黏膜层、黏膜下层和固有肌层,直肠癌术前T分期的总准确率为80%（16/20）。健康人直肠固有筋膜前、后、左、右侧的MRI显示率分别为71.7% （43/60）、96.7%（58/60）、90.0%（54/60）和83.3%（56/60）。Denonvillier′s筋膜、骶前筋膜、直肠骶骨筋膜、腹膜返折及下腹下丛的MRI显示率分别为68.8%（55/80）、65.0%（52/80）、87.8%（69/80）、86.3%（69/80）和90.0%（72/80）;直肠侧韧带的显示率较低,左侧为53.8%（43/80）,右侧为47.6%（38/80）。结论 高分辨MRI可以辨识直肠肠壁及其周围解剖细节,帮助直肠癌术前T分期及制定临床治疗方案,判断全直肠系膜切除手术的侧切缘是否浸润,提高微转移癌灶的手术切除率,减少手术并发症。

Objective To observe anatomic details of the rectal and its surrounding by high resolution magnetic resonance imaging（MRI）, and provide anatomic parameters and basis for clinical diagnosis and treatment of rectal cancer. Methods The pelvic multiple sequence parameter MRI of 60 normal people and 20 cases of rectal cancer patients were collected and evaluated by two radiologists with double blind method. MRI was used for T staging in 20 patients with rectal cancer and the pathological results were compared. The display rate of anterior, posterior, left and right of fascia propria of 60 cases of normal rectal, and the presacral fascia, sacral fascia, retrorectal space, peritoneal reflextion, rectal lateral ligament, inferior hypogastric plexus of all research objects were statistically analyzed. Results High resolution MRI could display clearly the mucosa, submucosa and muscularis propria. The accuracy of MR in the preoperative T staging of rectal cancer was 80%（16/20）. The display rate of anterior of fascia propria was 71.7% （43/60）, posterior was 96.7% （58/60）, left was 90.0% （54/60） and right was 83.3% （56/60）. The display rate of Denonvillier′s fascia was 68.8%（55/80）, anterior sacral fascia was 65.0%（52/80）, sacral fascia was 87.8%（69/80）, peritoneal reflextion was 86.3%（69/80） and inferior hypogastric plexus was 90.0%（72/80, the left of rectal lateral ligament was 3.8%（43/80） and right was 47.6%（38/80）. Conclusions High resolution MRI can clearly display the anatomical details of the rectal and its surrounding, help clinical treatment with preoperative T staging, judge whether the circumferential resection margin infiltration and improve the micrometastasis operation resection rate and reduce the operation complications.