直肠癌侧方淋巴结转移影像学评估

Lateral lymph nodes metastases diagnosed by multiimaging modalities

直肠癌侧方淋巴结转移的诊断至关重要,直接影响侧方淋巴结清扫的选择,放化疗方案的制定,以及病人预后的判断。目前,临床常用的直肠癌侧方淋巴结转移影像学诊断方法包括MRI、直肠腔内超声(ERUS)、多排螺旋CT(MDCT)、弥散加权成像(DWI)、PET-CT以及影像组学。迄今,淋巴结转移的影像学诊断标准尚未达成完全一致。尽管淋巴结形态被应用于转移性淋巴结诊断,但受限于研究者间一致性差,尚未在临床得到广泛应用。DWIMRI和PET-CT作为功能影像并未显著提高淋巴结诊断准确率。影像组学作为新的诊断方法已经被应用结直肠癌转移性淋巴结预测中。期待未来能够出现包括人工智能神经网络在内的更准确的方法用于术前诊断淋巴结。

Assessment of lymph node status in patients with rectal cancer is important before operation and neoadjuvant treatment because it has an influence on definition of operative plan, strategy of chemoradiotherapy and prognosis of the patients with rectal cancer. The imaging modalities that can be used to assess lymph node status including magnetie resonance imaging （MRI） , endorectal uhrasonography （ERUS） , multi-row detector computer tomography （MDCT）, diffusion-weighted imaging （DWI） , PET-CT, and radiomics. The imaging criteria for metastatic lymph nodes have not been reached. Although size combined with morphologic features would increase the accuracy of diagnosis before operation, the reproducibility and reliability can＇ t reach in high level which limits the application in clinical study and work. Unfortunately, functional imaging characteristics including DWI and PET can＇t predict metastatic lymph nodes more accurately compared with morphological imaging. Radiomicshas already been used in prediction and diagnosis metastatic lymph nodes. We need further clinical research and modalities including artificial neural networks on demonstration of sensitive and specific imaging biomarkers to predict metastatic lateral lymph nodes.