直肠癌术后局部复发的诊断与治疗

我们回顾性分析1990年至2005年我科收治的35例直肠癌术后局部复发再次手术患者的临床资料,现报告如下。临床资料1.一般资料:本组35例,男24例,女11例。年龄(50.1±6.8)岁。第一次手术行Mile术9例,行Dixon术26例。术后病检示高分化腺癌9例,中分化腺癌7例,低分化腺癌11例,黏液腺癌8例。Duke分期:B期16例,C期19例。2.诊断、治疗及结果:①局部复发的诊断途径:术后CEA异常31例,结肠镜检查发现新生物取病检明确诊断22例,直肠腔内超声,CT或MRI检查发现复发14例。②局部复发部位及复发时间:在35例患者中,17例为吻合口复发,11例为会阴部复发,7例…     

直肠癌术后局部复发的诊断和治疗

在直肠癌手术后手术野范围内发现与原发瘤病理性质相同的癌灶即为局部复发。直肠癌根治性切除术后局部复发率可高达40%左右。局部复发的诊断和治疗均较棘手,这是导致直肠癌病人死亡的重要原因之一。一、直肠癌术后局部复发的特点直肠癌术后局部复发最常见的复发部位是吻合口、会阴部、骨性骨盆、盆内邻近脏器、淋巴结及腹膜。直肠癌复发时,病人常有会阴部下坠感、持续性会阴骶尾疼痛感并放射至下肢。有时,在会阴部或经阴道可扪及肿块或硬结。肿块或硬结压迫髂血管,影响静脉回流,还可导致下肢肿胀。局部复发一般早于远处复发。大多数病人的局…     

胃癌术后复发、转移的影像学诊断

<正>术后复发、转移是导致进展期胃癌预后差的重要因素。胃癌术后复发主要包括残胃复发及吻合口复发,胃癌术后转移则常见于淋巴结、腹膜和肝脏转移。影像学对于判断胃癌术后复发、转移有重要价值,常用手段包括CT、磁共振成像(MRI)及正电子发射计算机断层显像(PET)等。近年来鲜见关于胃癌术后复发、转移影像学诊断的文献报道,但其早期检出及诊断对提高胃癌病人疗效和预后具有重要意义。本文将结合文献及临床经验,对影像学在胃癌术后复发、转移诊断的应用进行概述。     

中低位直肠癌局部复发诊断和治疗

中低位直肠癌根治手术后局部复发是诊断和治疗上的难题,常见复发的部位包括吻合口、会阴部、骨性骨盆、盆内邻近脏器,表现为便血、会阴部疼痛不适,盆腔和骶前肿物等。手术后定期体格检查、CT、核磁、肿瘤标记物是目前诊断直肠癌局部复发的重要方法。对局部复发直肠癌的治疗决策,应根据局部复发的类型、复发癌的生物学特性和浸润范围等因素进行综合分析,从而决定是采取手术为主的综合治疗还是行放化疗等策略。     

18F-FDG显像在诊断结直肠癌术后不同部位转移复发中的应用

目的:研究18F-FDG显像在结直肠癌术后不同部位转移复发中的诊断价值.方法:采用”F-FDG双探头符合线路显像,同机图像融合.结果:18F-PET/CT诊断结直肠癌术后吻合口复发的敏感度为100％,阴性预测值为100％,明显高于CT的61.5％和84.1％,18F-FDG PET/CT诊断结直肠癌术后周围淋巴结及远处转移的敏感度为97.9％,特异性为85.7％,准确性为94.1％,阳性预测值为93.9％,阴性预测值为94.7％.明显高于强化CT的66.0％、47.6％、60.3％、73.8％和38.5％(P＜0.05).结论:18F-FDG显像能明显提高结直肠癌转移复发的检出率,在不同部位转移复发的诊断中较常规影像学检查更有价值.     

钡灌肠和CT及MRI对结直肠癌诊断的比较影像学研究

目的比较钡灌肠(BE)、计算机X线断层扫描(CT)和磁共振成像(MRI)对结直肠癌检查的临床价值。方法对64例经临床拟诊结直肠癌患者的影像学资料进行对比分析。结果64例患者中39例行BE检查,31例行螺旋CT检查,42例行MRI检查。其中经手术病理证实的结直肠癌54例。BE、CT和MRI对结直肠癌检查的敏感度分别为96.9%、96.2%和97.1%;准确度分别为92.3%、83.9%和90.5%。CT和MRI对结直肠癌T分期诊断的准确度分别为73.1%和82.9%。结论BE是结直肠癌的基本影像学检查方法,CT和MRI是BE必要的补充检查手段,BE加MRI是诊断结直肠癌的优选组合检查方法。     

MR成像在直肠癌术前T分期患者中的诊断价值

目的分析MR成像用于直肠癌术前T分期的诊断效果及其价值。方法选取2017年2月至2020年3月直肠癌75例择期手术患者作为研究对象,患者均接受螺旋CT、MR成像检查,以手术病理结果为金标准,比较螺旋CT、常规MR平扫、MRI平扫+DWI+增强扫描3种方式的T分期结果,记录手术时间,4级评分法评价患者接受度。结果术后病理分期分别为:T_1期10例、T_2期15例、T_3期28例、T_4期22例。MRI平扫+DWI+增强扫描的T_1～T_4分期诊断准确率均高于螺旋CT、MR平扫,P0.05。螺旋CT、MR成像的诊断用时分别为(23.5±7.6)分钟、(25.4±9.3)分钟,患者接受度分别为(4.7±0.8)分、(5.1±1.6)分,两组诊断用时、患者接受度相比,P0.05。结论采取MRI平扫+DWI+增强扫描进行直肠癌术前T分期的综合诊断效能更佳,尤其是T4期准确率较高。     

直肠癌术后局部复发诊治体会

目的探讨直肠癌术后局部复发的诊断及治疗。方法回顾性分析1990年至2005年间我院收治的直肠癌Miles术后局部复发病例的诊断及治疗情况。结果复发多于术后2年内发现,复发部位多在盆腔、会阴及阴道壁,所有患者均出现会阴或骶尾部疼痛。有20例会阴触及硬结;8例阴道后壁出现结节隆起;有12例兼有肝、腹股沟淋巴结及胸椎转移。22例行盆腔会阴CT扫描,骶前可见散乱细条索影及密度增高团块影。12例经会阴局部切除,9例经骶尾做了扩大切除;另15例因晚期未能手术。结论对于直肠癌术后局部复发,早期诊断,病人全身状态允许,积极进行再手术治疗,可延长生存期。     

直肠癌全直肠系膜切除术的解剖基础及其磁共振诊断优势

直肠癌是消化道常见的恶性肿瘤，早期诊断、早期治疗是直肠癌诊治的重点。既往直肠癌的影像学诊断主要依据钡灌肠和CT检查，但这些影像技术都有一些公认的局限性。钡灌肠由于检查过程中患者的不舒适及投照的内在特性限制其诊断价值；CT检查具有明显的电离辐射和对比剂过敏现象。MRI可任意平面成像，多方位、多序列的显示病变，对直肠癌及其周围系膜筋膜的测量具有重要价值，已成为外科手术的重要辅助工具，尤其是伴随着功能MRI的发展和压脂序列的成熟应用.     

18F-FDG hPET/CT显像诊断结直肠癌术后复发转移

目的 评价^18F-FDG hPET／CT代谢显像对结直肠癌患者术后复发转移的诊断价值。方法 对81例结直肠癌术后临床可疑肿瘤复发或转移的患者采用GEHAWKEYE符合线路SPECT进行^18F-FDG显像，获得经X线衰减校正后的三维断层图像，由计算机完成各断层图像的融合，以目测法进行诊断分析，并与CT、病理学检查、临床随访作出的最后诊断进行对比。结果 ^18F-FDG hPET／CT代谢显像对结直肠癌术后复发、转移诊断的灵敏度为93％（57／61），特异性为80％（16／20），阳性预测率为93％（57／61），阴性预测率为80％（16／20）；而常规CT对结直肠癌术后复发转移诊断的灵敏度、特异性、阳性预测值、阴性预测值分别为67％（37／55）、73％（19／26）、84％（37／44）、51％（19／37）；^18F-FDG hPET／CT代谢显像共检出病灶126个，65例相同视野hPET／CT代谢显像与诊断CT常规影像检查复发转移病灶检出数分别为91个和46个。结论 ^18F-FDG hPET／CT显像对结直肠癌术后复发转移的诊断价值优于CT；通过与同机定位CT图像融合可有效地对病变进行定性定位。     

Pre-operative staging of rectal cancer: MRI or ultrasound?

Optimal management of rectal cancer depends on obtaining accurate and detailed staging information at the time of diagnosis. The majority of this comes from radiological staging investigations such as computed tomography (CT), magnetic resonance imaging (MRI) and endoanal ultrasound (EAUS). Whilst there is little debate on the use of CT to assess distant spread of disease, there is still variation in the use of MRI or EAUS in the local staging of rectal cancer. Both techniques have their roles but MRI is better able to visualise the entire rectum and mesorectum as well as accurately identify the circumferential resection (CRM) margin in relation to the tumour edge. Breach of the CRM is one of the most important predictors of local recurrence and knowledge of its relationship to the tumour determines initial management. MRI has additional advantages in being able to identify other poor prognostic factors such as extramural venous invasion (EMVI) and mucin deposition, which further influence oncological treatment. It also provides the surgeon with accurate information on the relationship of the tumour to surrounding structures and the sphincter complex which is important for surgical planning. This review highlights the important determinants of local staging in rectal cancer and presents the evidence to answer the question as to which is a better imaging modality—MRI or EAUS?     

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??iagnosis and treatment of local recurrent mid-lower rectal cancer WANG Zhen-jun. Department of General Surgery, Beijing Chaoyang Hospital,Capital Medical University, Beijing 100020,China Abstract Local recurrence of mid-lower rectal cancer persistently constitutes a challenging clinical problem. Recurrent lesion often located in anastomosis, perineum, osteal pelvis and adjacent organs in the pelvis. Clinical manifestation of local recurrent rectal cancer (LRRC) patients include blood stool, perineal pain, pelvic and presacral lump, et al. Regular postoperative physical examination, CT, MRI as well as tumor markers are important methods for diagnosis of LRRC. The treatment choice include excision as the main part of multimodality treatment or palliative radiochemotherapy on comprehensive analysis of type of recurrence, cancer biological features and involvement extent of recurrent cancer.     

Clinical assessment of positron emission tomography for the diagnosis of local recurrence in colorectal cancer.

BACKGROUND: The clinical value of positron emission tomography (PET) for the diagnosis of local pelvic recurrence of colorectal cancer was evaluated. METHODS: Computed tomography (CT) and magnetic resonance imaging (MRI) of the pelvis were performed at regular intervals in 23 patients who had undergone resection for colorectal cancer. The 23 patients had a total of 25 lesions. PET images of the 25 lesions and of six primary lesions in patients with rectal cancer were obtained. A differential absorption ratio (DAR) was calculated in order to examine the accumulation of [18F]2-fluoro-2-deoxy-D-glucose (18FDG) on PET images. Histological diagnoses of the pelvic masses were obtained by CT-guided needle biopsy. RESULTS: On CT or MRI, a pelvic mass with a spicular shape (n = 1) was non-recurrent, whereas a nodular or lumpy shape indicated a locally recurrent lesion (n = 10). Masses with a nodulospicular shape (n = 12) did not correlate with the histological features. On PET, 15 of 16 histologically proven local recurrences were imaged positively. By setting a DAR of 2.8 as a cut-off value, local recurrences could be diagnosed with 100 per cent accuracy. CONCLUSION: PET is a clinically useful tool for the detection of local recurrence of colorectal cancer, particularly for distinguishing between recurrence and granulation tissues in the pelvic cavity.     

MRI of extraperitoneal rectal carcinoma

Last years technological developments in imaging field have made a substantial contribution to diagnosis and staging of rectal cancer. Endorectal ultrasound and MRI with endorectal coil are very useful in rectal cancer initial staging thanks to their ability to distinguish between the rectal wall layers. Major ultrasound limitations are presence of inflammations, desmoplastic reaction and small field of view which limits evaluation of perirectal invasion. MRI with phased-array coils, instead, allows depiction of mesorectum and to assess the distance between tumor and mesorectal fascia. Unfortunately CT shows low accuracy compared to MRI in local staging because it fails to distinguish the rectal wall layers. The criterion used in assessing nodal involvement remains unfortunately still the dimensional one even if new contrast media based on nano-iron particles look promising in this regard On reassessment after chemo-radiotherapy treatment, MRI proved to be a very accurate tool thanks to its ability to detect tumor downstaging, disappearance of mesorectal fascia infiltration or even to show a complete response. The presence of recurrence can be studied by contrast enhanced perfusion-MRI or with good accuracy using PET which, however, presents major technical limitations at present.     

Fusion Image of Positron Emission Tomography and Computed Tomography for the Diagnosis of Local Recurrence of Rectal Cancer

Background The aim of this study was to evaluate the clinical and therapeutic value of digital fusion image (FI) of positron emission tomography (PET) using ¹⁸F-fluorodeoxy glucose and computed tomography (CT) in patients who were suspected of having a local recurrence of rectal cancer.Methods Forty-two patients (32 men and 10 women; mean age, 61.4 years, range, 40–79 years) with a suspicion of local recurrence after curative resection of rectal cancer were prospectively recruited and underwent ¹⁸F-fluorodeoxy glucose-PET and CT. The FI was reconstructed with a commercially available digital software program, T-B Fusion. Wilcoxon signed rank test was used to compare FI with CT alone or PET alone.Results FI yielded a correct diagnosis in 39 (93%) of 42 patients, whereas CT alone and PET alone did so in 33 (79%) and 37 (88%) patients, respectively. FI had better diagnostic accuracy than CT alone (P = .0138) and PET alone (P = .0156). Overall, FI altered patient management in 11 (26.2%) patients on the basis of additional information, including differentiation of the tumor from the postoperative scar in 6 patients, exact anatomical location in 3 patients, and both in 2 patients.Conclusions FI has a potential clinical value in the treatment of suspected local recurrence of rectal cancer.Presented at the 55th Annual Cancer Symposium of the Society of Surgical Oncology, Denver, Colorado, March 2002.     

Diffusion-weighted magnetic resonance imaging detects local recurrence after radical prostatectomy: initial experience

Current conventional cross-sectional imaging techniques, such as contrast-enhanced computed tomography and magnetic resonance imaging (MRI), are largely inaccurate in detecting local recurrence after radical prostatectomy. We report on five patients with biochemical recurrence after radical retropubic prostatectomy and pelvic lymph node dissection for whom local recurrence could only be detected with diffusion-weighted (DW) MRI. Prior to DW-MRI, all patients had negative digital rectal examinations, negative or equivocal conventional cross-sectional imaging, and negative bone scans. All suspicious lesions on DW-MRI imaging were histologically proved to be local recurrences of prostate cancer after either transrectal ultrasound-guided or transurethral biopsy. These results should encourage other centres to test our findings.     

The Utility of Molecular Imaging in Prostate Cancer

Prostate cancer is the commonest solid-organ cancer diagnosed in males and represents an important source of morbidity and mortality worldwide. Imaging plays a crucial role in diagnosing prostate cancer and informs the ongoing management of the disease at all stages. Several novel molecular imaging technologies have been developed recently that have the potential to revolutionise disease diagnosis and the surveillance of patients living with prostate cancer. These innovations include hyperpolarised MRI, choline PET/CT and PSMA PET/CT. The major utility of choline and PSMA PET/CT currently lies in their sensitivity for detecting early recurrence after radical treatment for prostate cancer and identifying discrete lesions that may be amenable to salvage therapy. Molecular imaging is likely to play a future role in characterising genetic and biochemical signatures in individual tumours, which may be of particular significance as cancer therapies move into an era of precision medicine.     

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??CT and MRI in the diagnosis of rectal cancer staging ZHANG Xiao-peng, SUN Ying-shi. Key Laboratory of Carcinogenesis and Translational Research, Department of Radiology, Cancer Hospital & Institute of Peking University, Beijing 100142, China
Correspondin author?? ZHANG Xiao-peng, E-mail??zxp@bjcancer.org
Abstract Rectal cancer is one of the most common causes of death from cancer. Accurate staging is necessary for optimal treatment. Preoperative staging is an essential factor in the multidisciplinary management of rectal cancer now because tumor stage is the strongest predictive factor for recurrence. The tumor node metastasis (TNM) system is used to describe numerically the anatomical extent of cancer. Various diagnostic methods provide accurate staging. Endorectal ultrasound (EUS) and magnetic resonance tomography are suitable for determining tumor T stage. US is better for T1~2 stage tumor especially. Moreover, MRI has some advantages in T and N stage of advanced rectal cancer. Modern multidetector row CT is predestined for detecting distant metastases as it is a widespread, fast, and reproducible method. MRI is highly accurate in predicting the circumferential resection margin. MRI provides accurate assessment of the tumor relative to the circumferential margin, that is, the mesorectal fascia, the anal and pelvic peritoneal fold, which is valuable for determining therapy protocol and therapy outcome.