磁共振成像对中低位局部进展期直肠癌新辅助放化疗后术前再分期的评估价值

Value of magnetic resonance imaging in assessing the efficacy of neoadjuvant chemoradiotherapy for locally advanced rectal cancer

目的 探讨磁共振成像（MRI）对直肠癌术前新辅助放化疗后分期的应用价值.方法 中低位局部进展期直肠癌患者56例,所有患者在新辅助放化疗后完成MRI检查并分期,最终经直肠全系膜切除术（TME）切除肿瘤,并进行病理分期,比较MRI分期与手术病理分期结果,分析MRI检查对TN分期、T分期及N分期判断的准确率.结果 MRI的T分期总准确率为78.6％ （44/56）,其中对T0、T1、T2、T3和T4各期诊断敏感性分别为66.7％、60.0％、78.9％、81.8％和85.7％.MRI对N分期诊断准确率为73.2％（41/56）,对N0和N＋诊断敏感性分别为80.0％和65.3％,TN分期诊断准确率为69.6％.结论 MRI对新辅助放化疗后T分期及N分期的判断均具有较高的准确性,是直肠癌术前分期最常用的检查手段之一.

Objective To explore the clinical value of magnetic resonance imaging （MRI） for staging rectal cancer after neoadjuvant chemoradiation （Neo.CRT）.Methods We retrospectively analyed the clinical data of 56 patients with rectal cancer between January 2010 and October 2015 in our hospital.MRI was performed before and after chemoradiotherapy in all patients.All patients underwent subsequent total mesorectal excision （TEM） and completed pathologic staging.The results of MRI were compared with the postoperatively pathologic staging.Results The overall accuracy of MRI for T was 78.6% （44/56）,while 8 patients （14.2%） were overstaged and 4 patients （7.1%） were understaged.The sensitivity predictive values for T0,T1,T2,T3 and T4 were 66.7%,60.0%,78.9%,81.8%,and 85.7%,respectively.The overall accuracy of MRI for N was 73.2% （41/56）,while 9 patients （16.1%） were overstaged and 6 patients （10.7%） were understaged.The sensitivity predictive values for N0,N＋ were 80.0% and 65.3%,respectively.Conclusion MRI has good accuracy in T stage and N stage diagnosis.It is one of the most common used detective methods in preoperative diagnosis of rectal cancer.