直肠充水后MRI检查对直肠癌新辅助治疗疗效的评估价值

Assessment value of MRI with rectal water filling in the efficacy of neoadjuvant chemoradiotherapy in rectal cancer

目的:探讨直肠充水后MRI检查对直肠癌新辅助治疗(neoadjuvant chemoradiotherapy,NCRT)后MRI T分期再分期的评估价值,并判断NCRT后的疗效。方法:回顾性分析2013年6月至2017年6月确诊为直肠癌病人39例,均进行NCRT,NCRT前、后均进行直肠充水后MRI检查,并将NCRT后的MRI T分期与术后病理分期进行对比分析,判断治疗后MRI检查结果的准确性。依据实体肿瘤评价的RECIST1.1标准评价直肠癌NCRT后的肿瘤退缩程度及疗效。结果:39例接受NCRT病人,其中29例病人均见不同程度降期,其降期率为74.4%;治疗后术前MRI T分期符合术后病理分期27例,其MRI诊断的总准确率为69.2%。NCRT前、后的MRI分期差异有统计学意义(P<0.01)。治疗后肿瘤长径和厚度均明显降低(P<0.01),根据RECIST1.1标准判断治疗的总有效率为53.8%。结论:直肠充水后MRI不仅能动态评估直肠癌NCRT前、后T分期的改变和肿瘤大小的变化,从而有效评估疗效,还可有效判定NCRT后T分期,为手术治疗提供依据。

Objective:To evaluate the value of MRI with rectal water filling in the MRI T restaging following neoadjuvant chemoradiotherapy(NCRT)in rectal cancer,and determine the efficacy of NCRT.Methods:Retrospective analysis was conducted in 39 patients with rectal cancer who were clinically diagnosed from June 2013 to June 2017,and treated with NCRT.Both before and after NCRT,MRI examination was performed after rectal water filling.The MRI stages after NCRT were compared with the postoperative pathological stages to determine the accuracy of the MRI results after treatment.Evaluation of tumor withdrawal degree and therapeutic effect after NCRT of rectal cancer based on the RECIST 1.1 standard of solid tumor evaluation.Results:Thirty-nine patients were treated with NCRT,and compared the MRI stages before and after treatment.Of these,Twenty-nine patients had different descending stages,and their descending rate was 74.4%.There were 27 cases of postoperative pathological staging with MRI staging before and after the treatment,and the overall accuracy of MRI diagnosis was 69.2%.The MRI staging before and after NCRT was statistically significant(P<0.01).After treatment,the tumor length and thickness were significantly reduced(P<0.01)The overall response rate for judging the therapeutic effect of tumors according to the RECIST 1.1 standard was 53.8%.Conclusions:MRI with rectal water filling can not only dynamically evaluate the changes of T staging before and after NCRT of rectal cancer and the changes of tumor size to effectively evaluate the efficacy,but also effectively determine the NCRT T staging,which can provide basis for surgical treatment.