开塞露在直肠癌MRI术前T1和T2分期中的应用

The value of Enema Glycerine applying in preoperative MRI T1 staging and T2 staging of rectal cancer

目的探讨使用开塞露进行肠道准备对直肠癌磁共振术前T1和T2分期的意义。材料与方法回顾经手术病理证实为T1或T2分期的直肠癌患者81例,男51例,女30例,平均年龄(64.2±12.2)岁。其中,45例(男30例,女15例)使用开塞露,36例(男21例,女15例)未使用开塞露。分别分析两组MRI术前分期与手术病理分期结果的一致性,计算并比较两组MRI T1、T2分期的敏感度、特异度、准确度、阳性预测值、阴性预测值和T1+T2分期的敏感度。结果 Kappa检验证实两组MRI术前分期与手术病理分期结果的一致性均为中等,K值分别为使用开塞露组0.693,未使用开塞露组0.537。使用开塞露组直肠癌磁共振T分期的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为T1分期:76.5%、92.9%、86.7%、86.7%、86.7%;T2分期:78.6%、76.5%、86.7%、84.5%、68.4%;T1+T2分期的敏感度为:77.8%。未使用开塞露组直肠癌磁共振T分期的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为T1分期:57.1%、95.5%、80.6%、88.9%、77.8%;T2分期:77.3%、57.1%、69.4%、73.9%、61.5%;T1+T2分期的敏感度为:69.4%。统计分析证实使用开塞露组T1分期的敏感度及T2分期的特异度、准确度高于未使用开塞露组(P<0.05,单侧)。结论使用开塞露进行肠道准备能够明显提高直肠癌磁共振T1分期的敏感度、T2分期特异度及准确度,同时在一定程度上提高T1和T1+T2分期的诊断准确性,建议作为直肠癌磁共振检查的肠道准备常规应用。

Objective： To evaluate the value of Enema Glycerine applied in preoperative MRI T1 staging and T2 staging of rectal cancer. Materials and Methods：The MRI datum of 81 cases of pathologically conifrmed T1 staging or T2 staging of rectal cancer suffers after operation （50 males and 31 females whose ages, 64.2＆#177;12.2 on average, range from 31 to 88）, were collected retroactively, from september 2005 to december 2013, in PUMCH. Patients involved were examined by MRI within two weeks before the operation. In this study, 45 patients （30 males and 15 females） had used the Enema Glycerine. While the other 36 cases （21 males and 15 females） had no used it. So these cases were assigned to two groups. The thesis utilized Kappa test to analyze the consistency between the preoperative MRI T staging and the postoperative pathological staging of in each group, and calculated the sensitivity, speciifcity, accuracy, positive predictive value and negative predictive value of the MRI T1 staging, T2 staging, and the the sensitivity of T1＋T2 staging, and compared them, respectively. Results：Kappa tests （K=0.693 and K=0.537） showed the two groups, including applying the Enema Glycerine and no applying the Enema Glycerine, have good consistency of the preoperative MRI T staging and the postoperative pathological staging. Respectively, in the group applying the Enema Glycerine, the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the MRI T1 staging were 76.5%, 92.9%, 86.7%, 86.7% and 86.7%. Those of the MRI T2 staging were 78.6%, 76.5%, 86.7%, 84.5%and 68.4%. The sensitivity of the MRI T1＋T2 staging was 77.8%. In the other group, no applying the Enema Glycerine, the sensitivity, speciifcity, accuracy, positive predictive value and negative predictive value of the MRI T1 staging were 57.1%, 95.5%, 80.6%, 88.9%and 77.8%. Those of the MRI T2 staging were 77.3%, 57.1%, 69.4%, 73.9%and 61.5%. The sensitivity of the MRI T1＋T2 staging was 69.4%. The statistic analysis show the sensitivity of the MRI T1 staging, the speciifcity and the accuracy of MRI T2 staging of the group applying the Enema Glycerine were higher than that of the group no applying the Enema Glycerine （P〈0.05, single-side hypothesis testing）. Conclusions：There is higher value of Enema Glycerine, which can signiifcantly improve the sensitivity of the preoperative MRI T1 staging, the speciifcity and accuracy of T2 staging, and simultaneously improve partly the diagnosis accuracy of the MRI T1 staging and T1＋T2 staging, applied in preoperative MRI examination of rectal cancer and thus it should be one of the conventional application.