MRI及多层螺旋CT在直肠癌术前T分期中的应用价值研究

The diagnostic value of MRI and MSCT in preoperative T staging of rectal cancer

目的研究MRI及多层螺旋CT(Multislice Spiral CT,MSCT)单一及联合诊断在直肠癌术前T分期的临床价值。方法回顾性分析本院2014年2月至2016年12月收治的65例直肠癌患者临床资料,患者术前均行MSCT及MRI检查。以病理结果为金标准,比较MSCT、MRI及联合检测对T_(1-2)、T_3、T_4期的诊断符合率,并将各检查的环周切缘状态与病理行Kappa一致性检验。结果三种检查的诊断符合率及T_(1-2)期诊断结果之间差异均有统计学意义(均P<0.05)。MRI和MSCT+MRI的诊断符合率及T_(1-2)期诊断结果均优于MSCT(均P<0.05)。MSCT、MRI的总体诊断结果与病理相比,差异均有统计学意义(均P<0.05),MSCT+MRI的总体诊断结果与病理相比,差异无统计学意义(P>0.05)。MRI和MSCT+MRI预测环周切缘与病理结果一致性较好,Kappa值分别为0.736和0.842。结论 MRI较MSCT在直肠癌术前T分期中有更高的临床参考价值,联合诊断价值相对单一诊断更优。

Objective To study the clinical value of MRI/CT single and combined diagnosis in preoperative T staging of rectal cancer. Methods A retrospective analysis of the clinical data of 65 cases of patients with rectal cancer admitted from February 2014 to December 2016 in our hospital were carried out. All patients were examined by MSCT and MRI before operation. The pathological results were regarded as the gold standard, and the coincidence rates of MSCT, MRI and combined diagnosis at T1-T2, T3 and T4 were compared with the diagnostic accordance rate. The Kappa consistency test was used for each staging diagnosis. Results There was significant difference in the diagnostic coincidence rate and the diagnosis of T（1-2） between the three examinations（P 〈 0.05）. The diagnostic accuracy of MRI and MSCT＋MRI and the diagnosis of T（1-2） were better than those of MSCT（all P 〈 0.05）. Compared to the results of pathology, the overall diagnostic outcomes of MSCT and MRI were distinctly significant（P 〈 0.05）, while there is no obvious significance between the MSCT＋MRI and pathological results（P 〈 0.05）. The MRI and MSCT＋MRI had a higher consistency to predict the circumferential resection margin with pathological findings, the Kappa values were 0.736 and 0.842 respectively. Conclusion Compared with MSCT, MRI has higher clinical reference value in preoperative T staging of rectal cancer, and combined diagnosis is superior to single diagnosis.