高分辨MRI可精准评估直肠癌术前分期及淋巴结转移

目的  探究高分辨MRI (HR-MRI)对于直肠癌术前分期以及淋巴结转移的评估价值。方法  回顾性选取2020年4月~2021年7月在本院接受手术治疗的直肠癌患者60例，收集其术前HR-MRI检查影像资料以及术中样本病理检测结果，对比HR-MRI检测、手术病理检测结果。结果  60例直肠癌手术病理检测显示，T1~2期、T3期、T4期肿瘤患者分别有患者20例、32例、8例，术前HR-MRI检测结果为17例、38例、5例，两者差异无统计学意义(H_C=0.012，P=0.914)。HR-MRI诊断T1~2期的敏感度/特异性分别为85.00%、100.00%，检测T3期肿瘤的敏感度/特异性分别为93.75%、71.43%，T4期分别为62.50%、96.15%，3种分期的敏感度、特异性差异无统计学意义(特异性：χ²=0.302、P=0.289；敏感度：χ²=0.408、P=0.378)。病理检测显示，60例直肠癌患者病理、HR-MRI检测同时存在的淋巴结有289枚，病理检测有129枚淋巴结呈转移阳性，占比44.64%，转移阴性160枚(55.36%)。HRMRI诊断淋巴结转移阳性113枚(39.10%)、淋巴结转移阴性176枚(60.90%)，HR-MRI诊断淋巴结是否发生转移的特异性/敏感度为72.87%、88.13%，诊断符合率为81.31%。结论  HR-MRI可精确诊断评估直肠癌术前分期、淋巴结转移情况，与手术病理检测结果相似，可为临床制定直肠癌手术方式提供可靠依据，值得临床重视。

Value of high-resolution MRI for assessing preoperative staging and lymph node metastasis in rectal cancer

  Objective  To explore the value of high-resolution MRI (HR-MRI) in evaluating preoperative stage and lymph node metastasis of rectal cancer.  Methods  We retrospectively reviewed 60 patients with rectal cancer who underwent surgery in our hospital from April 2020 and July 2021, and their preoperative HR-MRI data and intraoperative sample pathological test results were collected to compare HR-MRI test and surgical pathological test results.  Results  The surgical pathological results showed 20, 32 and 8 patients with stage T1-2, T3 and T4, respectively, and the Preoperative HR-MRI findings showed 17, 38 and 5 patients, respectively with no significant difference (H_C=0.012, P=0.914).The sensitivity/specificity of HR-MRI was 85.00% and 100.00% for the diagnosis of stage T1-2, 93.75% and 71.43% for the detection of stage T3 tumours, and 62.50% and 96.15% for stage T4, respectively, with no statistically significant differences in sensitivity and specificity between the three stages (specificity: χ2=0.302, P=0.289; sensitivity: χ2=0.408, P=0.378). Surgery and pathological examination showed that there were 289 lymph nodes were simultaneously present in 60 rectal cancer patients by pathology and HR-MRI, 129 (44.64%) lymph nodes were positive and 160 (55.36%) were negative for metastasis in pathological examination. 113 (39.10%) lymph nodes were positive for metastasis and 176 (60.90%) were negative for metastasis. The specificity and sensitivity of HR-MRI in diagnosing whether lymph nodes had metastasis were 72.87% and 88.13%. The diagnostic coincidence rate was 81.31%.  Conclusion  HR-MRI can accurately diagnose and evaluate the preoperative stage and lymph node metastasis of rectal cancer, and the results are similar to surgical pathological results. It can provide a reliable basis for clinical planning of rectal cancer surgery and deserve clinical attention.