高分辨率磁共振成像与正电子发射计算机体层显像仪在直肠癌周围转移性小淋巴结检出及术前T分期诊断中的应用价值

Application value of high resolution magnetic resonance imaging and positron emission tomography and computed tomography in the detection of peripheral metastatic small lymph nodes and preoperative T staging in rectal cancer

目的探讨高分辨率磁共振成像(MRI)与正电子发射计算机体层显像仪(PET/CT)在直肠癌周围转移性小淋巴结检出及术前T分期诊断中的应用价值。方法回顾性分析2019年8月至2021年12月解放军东部战区总医院秦淮医疗区收治的109例直肠癌患者的临床资料,以病理学结果为金标准,分析不同方法(高分辨率MRI与PET/CT检查)在周围转移性小淋巴结、术前T分期筛查中的价值。结果病理诊断结果显示,109例直肠癌患者中周围转移性小淋巴结352个,T_(1)~T_(2)分期26例,T_(3)分期68例,T_(4)分期15例。高分辨率MRI与金标准对周围转移性小淋巴结及术前T_(1)~T_(2)、T_(3)分期的诊断具有一致性(Kappa=0.565、0.705、0.750,P<0.05),对术前T_(4)分期诊断无一致性(P>0.05);PET/CT与金标准对周围转移性小淋巴结及术前T_(1)~T_(2)、T_(3)分期的诊断具有一致性(Kappa=0.696、0.590、0.455,P<0.05),对术前T_(4)分期诊断无一致性(P>0.05);二者联合与金标准对周围转移性小淋巴结及术前T_(1)~T_(2)、T_(3)、T_(4)分期的诊断具有较强的一致性(Kappa=0.838、0.808、0.865、0.709,P<0.05)。高分辨率MRI联合PET/CT在周围转移性小淋巴结、术前T分期筛查中灵敏度、特异度均高于90%。结论高分辨率MRI联合PET/CT对直肠癌周围转移性小淋巴结检出率较高,且联合检查在术前T分期中具有较高的诊断价值。

Objective To investigate the application value of high resolution magnetic resonance imaging(MRI)and positron emission tomography and computed tomography(PET/CT)in the detection of peripheral metastatic small lymph nodes and preoperative T staging in rectal cancer.Methods The clinical data of 109 patients with rectal cancer admitted to Qinhuai Medical District of the Chinese People’s Liberation Army Eastern Theater General Hospital from August 2019 to December 2021 were retrospectively analyzed.Taking the pathological results as the gold standard,the value of different methods(high resolution MRI and PET/CT examination)in screening peripheral metastatic small lymph nodes and preoperative T staging were analyzed.Results Pathological diagnosis showed that 352 peripheral metastatic small lymph nodes were found in 109 patients with rectal cancer,including 26 cases in T_(1)-T_(2) staging,68 cases in T_(3) stage,and 15 cases in T_(4) staging.High-resolution MRI was consistent with the gold standard in the diagnosis of peripheral metastatic small lymph nodes and preoperative T_(1)-T_(2),T_(3) staging(Kappa=0.565,0.705,0.750,P<0.05),there was no consistency in the diagnosis of preoperative T_(4) staging(P>0.05).PET/CT was consistent with the gold standard in the diagnosis of peripheral metastatic small lymph nodes and preoperative T_(1)-T_(2),T_(3) staging(Kappa=0.696,0.590,0.455,P<0.05),there was no consistency in the diagnosis of preoperative T_(4) staging(P>0.05).The combination of the two methods had strong consistency with the gold standard in the diagnosis of peripheral metastatic small lymph nodes and preoperative T_(1)-T_(2),T_(3),T_(4) stage(Kappa=0.838,0.808,0.865,0.709,P<0.05).The sensitivity and specificity of high-resolution MRI combined with PET/CT in the screening of small peripheral metastatic lymph nodes and preoperative T staging were higher than 90%.Conclusion High-resolution MRI combined with PET/CT has a high detection rate of peripheral metastatic small lymph nodes around rectal cancer,and the combined examination has a high diagnostic value in preoperative T staging.