MRI结合腔内充盈耦合剂对直肠癌术前评估的应用研究

目的探讨直肠MRI结合腔内充盈耦合剂对直肠癌术前评估的价值。 方法选取直肠癌76例，所有患者均行直肠MRI检查及腔内充盈耦合剂后MRI检查，分别评估肿瘤的T分期、N分期、系膜血管受侵、环周切缘情况，并与术后病理结果进行对比分析。 结果直肠MRI对于直肠癌T分期与术后病理一致58例，总体符合率76.3%。N分期与术后病理一致55例，总体符合率72.3%（Kappa=0.572，χ2=24.366，P＜0.001）。系膜血管受侵（extramural vascular invasion，EMVI）分析MRI与病理一致55例，其中EMVI（+）误判为EMVI（-）9例，EMVI（-）误判为EMVI（+）12例，总体符合率72.3%（Kappa值=0.564，χ2=23.677，P＜0.001）。环周切缘（circumferential margin，CRM）分析MRI与病理一致68例，其中CRM（+）误判为CRM（-）4例，CRM（-）误判为CRM（+）4例，总体符合率89.5%（Kappa值=0.754，χ2=8.556，P=0.004）。直肠腔内充盈耦合剂后MRI对于直肠癌T分期与术后病理一致66例，总体符合率86.8%，与直肠MRI检查符合率经卡方检验（Kappa值=0.736，χ2=3.102，P=0.043）。N分期与术后病理一致55例，总体符合率72.3%，与直肠MRI检查符合率经卡方检验（Kappa值=0.569，χ2=0.000，P=1.000）。EMVI分析MRI与病理一致61例，其中EMVI（+）误判为EMVI（-）7例，EMVI（-）误判为EMVI（+）8例，总体符合率80.3%，与直肠MRI检查符合率经卡方检验（Kappa值=0.612，χ2=1.314，P=0.252）。CRM分析MRI与病理一致65例，其中CRM（+）误判为CRM（-）4例，CRM（-）误判为CRM（+）7例，总体符合率85.5%，与直肠MRI检查符合率经卡方检验（Kappa值=0.712，χ2=0.543，P=0.465）。 结论直肠MRI结合腔内耦合剂可提高判断直肠癌术前T分期、系膜血管受侵的准确率，对于判断N分期、环周切缘情况的准确率无明显影响。

Application of MRI combined with intraluminal filling coupling agent in preoperative evaluation of rectal cancer

ObjectiveTo evaluate the value of rectal MRI combined with intraluminal filling coupling agent in preoperative evaluation of rectal cancer.MethodsA total of 76 cases of rectal cancer were reviewed. All patients underwent rectal MRI examination and MRI examination after intraluminal filling of coupling agent. The T stage, N stage, mesangial vessel invasion and circumferential margin of the tumors were evaluated respectively. The results were compared with the pathological results after operation.ResultsRectal MRI was consistent with postoperative pathology in 58 patients with rectal cancer T stage, the overall coincidence rate was 76.3%. N stage was consistent with postoperative pathology in 55 cases, the overall coincidence rate was 72.3%(Kappa=0.572, χ2= 4.366, P＜0.001). EMVI analysis showed that MRI was consistent with pathology in 55 cases, EMVI(+) was misdiagnosed as EMVI(-) in 9 cases and EMVI(-) was misdiagnosed as EMVI(+)in 12 cases. The overall coincidence rate was 72.3%(Kappa=0.564, χ2= 23.677, P < 0.001). According to CRM analysis, 68 cases were consistent with pathology, including 4 cases of CRM(+) and 4 cases of CRM(-)were misdiagnosed . The overall coincidence rate was 89.5%(Kappa=0.754, χ2= 8.556, P=0.004). Sixty-six cases of rectal cancer T staging were consistent with postoperative pathology after filling the rectum cavity with coupling agent, the overall coincidence rate was 86.8%, and the coincidence rate with rectal MRI was analyzed by chi square test(Kappa=0.736, χ2= 3.102, P=0.043). N staging was consistent with postoperative pathology in 55 cases, with an overall coincidence rate of 72.3%. The coincidence rate with rectal MRI was examined by chi square test(Kappa=0.569, χ2= 0.000, P=1.000). EMVI analysis showed that MRI was consistent with pathology in 61 cases, among which EMVI(+) was misjudged as EMVI(-) in 7 cases and EMVI(-) was misjudged as EMVI(+) in 8 cases. The overall coincidence rate was 80.3%. The coincidence rate with rectal MRI was verified by chi square test(Kappa=0.612, χ2= 1.314, P=0.252). According to CRM analysis, 65 cases were consistent with pathology, including 4 cases of CRM(+) and 7 cases of CRM(-) were misdiagnosed. The overall coincidence rate was 85.5%. The coincidence rate of MRI and rectal MRI was analyzed by chi square test(Kappa=0.712, χ2= 0.543, P=0.465).ConclusionRectal MRI combined with intraluminal coupling agent can improve the accuracy of preoperative T staging and mesangial vessel invasion in rectal cancer, but has no significant influence on the accuracy of N staging and circumferential margin.