3.0T MRI与CT在评价术前新辅助放疗或同步放化疗对中晚期低位直肠癌疗效中的应用价值

Application Value of 3.0T MRI and CT in Evaluating the Efficacy of Middle and Late Stage Low Rectal Cancer After Neoadjuvant Chemoradiotherapy

目的对比3.0T MRI与CT在评价术前新辅助放疗或同步放化疗(Neoadjuvant Chemoradiotherapy,NACRT)对中晚期低位直肠癌疗效的应用价值。方法选取2016年2月至2018年2月在我院就诊的182例直肠癌患者,随机分为两组:研究组90例,在NACRT前后采用MRI进行检查;对照组92例,在NACRT前后采用MSCT进行检查。分析NACRT前后两组患者肿瘤体积、T分期、N分期以及环固切缘受累(Circumferential Resection Margin,CRM)的改变,并与病理学结果进行对照。结果研究组和对照组在NACRT前后T分期、N分期变化差异均具有统计学意义(P<0.05)。与术后病理结果对照,研究组NACRT后T分期的一致性结果较好(Kappa=0.552),CRM受累情况一致性较好(Kappa=0.702),而N分期的一致性较差(Kappa=0.342)。与术后病理结果对照,对照组NACRT后T分期的一致性结果较好(Kappa=0.514),CRM受累情况一致性较好(Kappa=0.683),而N分期的一致性较差(Kappa=0.297)。两组患者T分期、N分期以及CRM受累情况的准确率比较,无统计学意义(χ^2=0.009、0.000、0.043,P均>0.05)。结论NACRT可以明显缩小肿瘤体积,降低分期,但对CRM无明显影响。MRI和MSCT均能准确判断肿瘤浸润程度,MRI一致性优于MSCT,但准确性无明显差异。

Objective To compare the value of T MRI and CT in evaluating the efficacy of middle and late stage low rectal cancer after neoadjuvant chemoradiotherapy(NACRT).Methods A total of 182 patients with rectal cancer who were admitted to our hospital February 2016 to February 2018 were selected as the study subjects.Patients were randomly divided into two groups:90 cases in the study group were examined by MRI before and after NACRT;92 cases in the control group were examined by MSCT before and after NACRT.The changes of tumor volume,T stage,N stage and circumferential margin(CRM)of patients in the two groups before and after NACRT were analyzed and compared with pathological results.Results For the two groups,there were significant differences in T and N stages before and after NACRT(P<0.05).Compared with the pathological results after operation,the consistency of T staging after NACRT in the study group was good(Kappa=0.552),the consistency of CRM involvement was good(Kappa=0.702),and the consistency of N staging was poor(Kappa=0.342).Compared with the pathological results after operation,the consistency of T staging after NACRT in the control group was good(Kappa=0.514),the consistency of CRM involvement was good(Kappa=0.683),and the consistency of N staging was poor(Kappa=0.297).There was no significant difference in the accuracy of T staging,N staging and CRM involvement between the two groups(χ^2=0.009,0.000 and 0.043,P>0.05).Conclusion NACRT can significantly reduce tumor volume and reduce staging,but it has no significant impact on CRM.Both MRI and MSCT can accurately determine the degree of tumor infiltration.MRI consistency is better than MSCT,but there is no significant difference in accuracy.