高分辨磁共振对结直肠癌术前分期和肿瘤分化程度的诊断价值

Diagnostic Value of High Resolution Magnetic Resonance Imaging in Preoperative Staging and Tumor Differentiation of Colorectal Cancer

目的探讨高分辨磁共振对结直肠癌术前分期和肿瘤分化程度的诊断价值。方法收集经结直肠镜活检确诊为结直肠癌患者52例,所有患者均使用飞利浦3. 0TX超导磁共振扫描常规MR序列(T1、T2)及MR功能成像(DWI、DCE-MRI),对比术后病理分期,评估结直肠癌术前MR TN分期的准确性,探讨结直肠癌病理分化程度与ADC值的相关性;在DCE-MRI图像上绘制时间-信号曲线特点,寻求其表现特性及诊断价值。结果 52例患者行手术治疗,对比术后病理结果,结直肠癌MRI T分期和N分期的准确率分别为88. 5%(46/52)和82. 7%(43/52),Kappa检验结果显示两者T分期高度一致,N分期一致性程度比较强;随着结直肠癌分化程度增高,其ADC值逐渐增加(P <0. 05); 46例结直肠腺癌患者时间信号曲线分布有差异,时间-信号曲线随着肿瘤分化程度的减低,呈现由I型向IV转化趋势。结论高分辨磁共振及功能成像能够准确评估结直肠癌的术前TN分期并对肿瘤分化程度有一定的诊断价值,为临床选择合理的治疗方案提供帮助。

Objective To evaluate the diagnostic value of high resolution magnetic resonance imaging in preoperative stage of colorectal cancer and the degree of tumor differentiation.Methods 52 patients with colorectal cancer were enrolled.All patients were scanned with Philips 3.0 TX superconducting magnetic resonance scanning conventional MR(T 1,T 2)and functional MRI(DWI,DCE-MRI).Compared with the postoperative pathological stage,evaluate the accuracy of preoperative MR TN staging in colorectal cancer,and to discuss the correlation between the degree of histological differentiation and ADC value in colorectal cancer.The time-intensity curve was plotted on the DCE-MRI image to find its performance characteristics and diagnostic value.Results 52 patients underwent surgical treatment,compared with postoperative pathological results,the accuracy rate of colorectal cancer MRI T staging and N staging were 88.5%,82.7%,respectively.Kappa test results showed that both T stage and N stage was relatively strong.With the tumor differentiation of colorectal cancer increasing,the ADC value of colorectal cancer increased gradually.The time signal curve of 46 cases of colorectal mucosal adenocarcinoma was different,and the time signal curve changes from I to IV with the decrease of tumor differentiation.Conclusion High resolution magnetic resonance imaging and functional imaging can accurately assess the preoperative TN staging of colorectal cancer,and have definite diagnostic value for tumor differentiation,which can help to select a reasonable treatment regimen for colorectal cancer.