磁共振成像检查在直肠癌临床分期、环周切缘及壁外血管侵犯判断中的准确性

The accuracy of MRI examination in the judgment of clinical staging,CRM and EMVI of rectal cancer

目的:探讨磁共振成像(MRI)检查在直肠癌临床分期、环周切缘(CRM)及壁外血管侵犯(EMVI)判断中的准确性。方法:选取医院收治的经病理证实确诊的184例直肠癌患者,术前均行MRI检查,比较影像学和病理学对直肠癌临床分期、CRM状态及EMVI情况。结果:184例直肠癌患者中MRI评估准确率T1期71.43%,T2期90.00%,T3期87.95%,T4期92.86%,MRI与病理学T分期具有较高一致性(Kappa=0.772,P<0.05);N0期正确率95.74%,N1期正确率73.26%,N2期正确率80.00%,MRI与病理学N分期具有中度一致性(Kappa=0.561,P<0.05)。184例患者中,病理学显示有68例患者存在CRM受累(CRM阳性),116例患者未受累(CRM阴性);MRI正确判定其中159例。相比于病理学检查,两者对CRM受累与否的判断具有很好的一致性(Kappa=0.815,P<0.05)。184例患者中,病理学显示35例患者存在EMVI阳性,149例患者未存在EMVI阴性,MRI正确判定其中161例,相较于病理学检查,两者对EMVI与否的判断具有很好的一致性(Kappa=0.789,P<0.05)。结论:MRI检查可较为准确地评估直肠癌患者临床分期,对是否出现CRM受累及EMVI状态提供较好的评估,有助于为临床制定个体化治疗方案及评估预后等方面提供影像依据。

Objective:To explore the accuracy of magnetic resonance imaging(MRI)in the judgment of clinical staging,circumferential resection margin(CRM)and extra mural vascular invasion(EMVI)of rectal cancer.Methods:184 patients with rectal cancer who were confirmed by pathological experiments in hospital were selected.All patients underwent MRI examination before surgery.And the clinical staging,CRM status and EMVI status of rectal cancer between iconography and pathology were further compared.Results:In 184 patients with rectal cancer,the accuracies of MRI assessment for T1 stage,T2 stage,T3 stage and T4 stage were 71.43%,90.00%,87.95%and 92.86%,respectively.The MRI results had higher consistence with the results of T staging of pathology(kappa=0.772,P<0.05).The correct rates of N0 stage,N1 stage and N2 stage were 95.74%,73.26%and 80.00%,respectively.And the results of kappa calculation showed that there was moderate consistency between MRI and pathological N staging(kappa=0.561,P<0.05).Among the 184 patients,the results of pathology showed that there were 68 patients with CRM involvement(CRM+)and 116 patients without CRM involvement(CRM-),and MRI correctly determined 159 of them.Compared with pathological examination,there was a favorable agreement between the two methods for whether there is CRM involvement(kappa=0.815,P<0.05).In 184 patients,the results of pathology showed that there were 35 patients with EMVI(EMVI+)and 149 patients without EMVI(EMVI-),and 161 cases of them were correctly identified by MRI.Compared with pathological examination,there was a favorable agreement between the two methods(kappa=0.789,P<0.05).Conclusion:MRI can more accurately assess the clinical staging of patients with rectal cancer,and can provide a better assessment for whether there is CRM involvement and EMVI situation,respectively,which is helpful to provide the imaging basis for formulating individual therapeutic schedule and assessing prognosis and other aspects in clinical work.