多模态MRI对直肠癌术前分期的诊断价值

Value of multimodal MRI in preoperative staging of rectal carcinoma

目的:探讨多模态MRI检查[T_(2)WI、快速反转恢复抑脂序列(T_(2)-TIRM)、DWI、动态增强扫描]对直肠癌术前分期的诊断价值。方法:回顾性分析经手术病理证实的69例直肠癌患者的MRI资料,患者术前行T_(2)WI、DWI、T_(2)-TIRM及动态增强扫描。以术后病理分期为金标准,计算多模态MRI对直肠癌术前T、N分期的准确率、敏感度及特异度。术前多模态MRI与术后病理分期的一致性行Kappa检验。结果:多模态MRI检查对术前T分期诊断总准确率为89.9%,T_(1)、T_(2)、T_(3)、T_(4)期诊断敏感度分别为66.7%、88.9%、91.2%、100.0%,特异度分别为100.0%、92.2%、94.3%、98.3%,准确率分别为97.1%、91.3%、92.7%、98.5%。MRI术前T分期与病理分期的一致性极好(K=0.845,P<0.001)。MRI术前N分期诊断总准确率为57.9%,N_(0)、N_(1)、N_(2)期诊断敏感度分别为64.5%、54.2%、50.0%,特异度分别为76.9%、73.2%、87.5%,准确率分别为72.5%、59.4%、81.2%。MRI术前N分期与病理分期的一致性较差(K=0.342,P<0.001)。结论:多模态MRI能对直肠癌术前T分期作出准确诊断,可指导临床合理选择治疗方案,但对N分期评价尚需进一步探讨。

Objective:The purpose of this study was to investigate the application value of T_(2)WI,T_(2)-TIRM,DWI and dynamic contrast enhanced scanning in preoperative staging diagnosis of rectal cancer.Methods:The MRI images and clinical data of 69 patients with rectal cancer were collected and analyzed retrospectively.All patients underwent MRI T_(2)WI,T_(2)-TIRM,DWI and dynamic contrast enhanced scanning before surgery.The postoperative pathological stage was taken as gold standard,the diagnostic accuracy,sensitivity and specificity of multimodal MRI in preoperative T and N staging of rectal cancer were calculated.The consistency between preoperative and pathology were checked by Kappa test.Results:The total accuracy of multimodal MRI in T staging was 89.9%.The sensitivity in T_(1),T_(2),T_(3) and T_(4) stage were 66.7%,88.9%,91.2%,100.0%,and the specificity were 100.0%,92.2%,94.3%,98.3%,and the accuracy were 97.1%,91.3%,92.7%,98.5%,respectively.The preoperative T stage had good consistency with the pathological stage(K=0.845,P<0.001).The total accuracy in N staging was 57.9%.The sensitivity in N_(0),N_(1),N_(2) stage were 64.5%,54.2%,50.0%,and the specificity were 76.9%,73.2%,87.5%,and the accuracy were 72.5%,59.4%,81.2%,respectively.The preoperative N stage had poor consistency with the pathological stage(K=0.342,P<0.001).Conclusions:Multimodal MRI examination can accurately evaluate the preoperative T staging of rectal cancer,which can guide the clinical choice of treatment.However,the value of evaluating N staging needs further study.