超声检查在直肠癌诊断中的应用

直肠癌为常见的恶性肿瘤之一,直肠指检和直肠乙状结肠镜检是常规的筛查直肠癌的方法,随着超声技术的发展,超声检查也和腹盆腔CT、MRI一样,成为直肠癌常用的影像学检查方法。超声检查包括经腹超声和腔内超声,在直肠癌的诊断、术前对直肠癌的局部浸润程度评估和肿瘤分期方面都可以为临床提供重要的信息。     

直肠腔内超声扫描检查对早期直肠癌术式选择的指导意义

本文报道了经手术和病理证实的早期直肠癌１１例，直肠腔内超声病灶检出率为１００％，其超声图像分为息肉隆起型和扁平隆起型二类。超声判断直肠癌浸润深度与病理符合率为７２．７％，超声判断早期直肠癌浸润深度有过深倾向，直肠腔内超声检查是判断直肠癌浸润深度的理想手段，直肠癌病人术前常规行直肠腔内超声检查，可为早期直肠癌病人术式选择提供客观依据。     

腔内三维超声扫查在直肠癌术前分期中的应用

自１９９１年１１月～１９９２年１２月，我们对６３例直肠癌病人进行了直肠腔内三维超声检查，旨在对直肠癌的分期进行前瞻性研究。结果：腔内三超声对直肠癌浸润深度判断的总符合率为９３．６５％，对淋巴结转移癌诊断的符合率为９２．１％。对直肠癌进行术前Ｄｕｄｅｓ分期与病理的总率为９３．６５％，Ｐ＜０．００１。因此，我们认为腔内三维超声可有效的判断直肠癌浸润深度，可靠的检测淋巴结转移情况，准确的用于术前Ｄｕｋｅ     

直肠内超声在直肠癌分期中的价值(文献综述)

1956年 Raid 和 Wild 曾设想用腔内超声扫描诊断直肠癌复发。由于技术原因,直至1983年Drag-sted等才首次在临床实践并获得成功。近代结直肠外科的发展,对早期直肠癌和位于括约肌以上的低位直肠癌仅侵及固有肌层者,主张作局部切除或保留括约肌手术。然而,手术方式的选择和估价预后必须基于术前对肿瘤浸润深度与范围的正确判断。迄今常用的直肠指检、钡剂灌肠、内窥镜和 CT 检查等方法,都不足以充分提供肿瘤浸润深度、方向、直肠外扩散程度以及邻近脏器的受累情况,直肠内超声扫描可望解决以上问题。     

经直肠腔内超声、MRI检查对直肠癌术前T分期诊断的价值分析

目的:比较经直肠腔内超声(TRUS)、MRI检查对直肠癌术前T分期的诊断价值.方法:以2018年7月至2020年9月我院收治且行手术治疗的86例直肠癌患者为研究对象,患者术前均接受TRUS和MRI检查,以术后病理T分期结果为金标准,比较TRUS、MRI对直肠癌T分期诊断的完全符合率和基本符合率.基本符合是指术后病理分期...     

经直肠超声在早期直肠癌诊断中应用初步探讨

目的 总结TRUS对直肠癌浸润深度诊断准确性,分析探讨TRUS在早期直肠癌诊断中的应用.方法 2002年1月至2007年10月163例直肠癌患者术前行TRUS检查,参考国际抗癌联盟有关直肠癌分期标准进行浸润深度分期诊断,并与手术病理结果对照.163例直肠癌中经病理检查证实16例为早期癌.研究病例术前均未接受放化疗.结果 TRUS对早期直肠癌(pT1)诊断灵敏性为87.5%(14/16),特异性达98.6%(145/147),阳性预测值为87.5%(14/16).对早期癌浸润深度进一步分析,TRUS对黏膜癌及黏膜下层癌诊断灵敏性分别为85.7%(6/7)、66.7%(6/9).16例早期癌(pT1)经肛门注水充盈直肠后再次行TRUS检查,病变均显示清晰.14例正确诊断为pT1期;未充盈直肠的情况下,仅6例病变显示清晰,仅3例诊断正确.早期癌声像图表现分为二型:隆起型、溃疡型,以隆起型多见,占81.6%(13/16).结论 TRUS在早期直肠癌的诊断中是一项有价值的影像学方法,经肛门注水充盈直肠后,明显提高了早期癌病变显示率及诊断准确性.     

经直肠超声在直肠癌治疗决策中的应用价值及进展

直肠癌是我国第五大常见的恶性肿瘤,病死率也高居第5位,近年来由于饮食习惯改变等因素发病率仍有上升。由于治疗方法的多样化,直肠癌术前准确的TNM分期对于临床制定最佳治疗方案及预后判断尤为关键。经直肠腔内超声(ERUS)是目前公认为术前评估肿瘤分期的一种快速、安全而准确的首选影像学方法。ERUS诊断直肠癌浸润深度和术后复发的准确性及敏感度均高于CT,而与MRI相当,已被临床广泛应用于辅助制定直肠癌患者的治疗方案;但对于淋巴结转移的评估准确性仍较低。近年来发展的超声新技术如超声造影、超声弹性成像及三维超声有望提高直肠癌术前分期的准确性并减少分期过高或过低的问题,具有潜在的临床应用价值。     

CT与MRI在直肠癌分期诊断中的应用

直肠癌是消化道系统常见恶性肿瘤,依据直肠癌的不同分期采用不同的治疗方法,术前准确判断直肠癌分期是合理制定治疗方案的关键。目前,在国内用于直肠癌术前分期的影像学检查方法主要有CT、MRI和超声内镜。任何一种影像检查方法都有其自身的优势和不足,没有哪种方法可以对直肠癌分期的各个方面的诊断均作出满意的回答。直肠癌T分期,目前较好的影像学检查方法主要是腔内超声和MRI,尤其是T分期较早病例,腔内超声分期更准确,进展期直肠癌和N分期,MRI有一定优势。对于M分期,CT和MRI都能满足临床需要,但CT对于腹部其他结构的显示更清晰,同时,还可以一次完成腹、盆腔检查。MRI具有较好的T、N分期能力的同时,还可以准确显示直肠癌TME手术相关的精细解剖结构,准确评估癌肿边缘与直肠系膜筋膜、肛门及盆腔腹膜反折等邻近解剖结构的关系,对于决定治疗方案和TME手术效果价值较大。     

腔内超声在诊断直肠肿瘤中的地位

目的 旨在探讨直肠腔内Ｂ超扫描在术前分期、判断局部浸润和淋巴扩散中的价值。方法 采用日本Ａｌｏｋａ－ＳＳＤ－２０型实际超声显像仪,棒状单平面７．５ＭＨｚ探头对１００例直肠肿瘤进行术前直肠腔内扫描。结果：在１３你直肠腺瘤中对局部浸润深度的诊断全部正确。８７例直肠癌中对局部浸润深度的诊断正确率为８２．７６％。故全组对局部浸润深度的诊断正确率为８５％。对肠外淋巴结受累的诊断正确率为７５％。对邻近器官受累     

核磁共振与腔内超声对直肠癌术前局部分期的价值比较

目的 比较核磁共振(MRI)和腔内超声(EUS)对直肠癌术前分期的价值.方法 分别应用MRI和EUS检查对72例和55例直肠癌患者行术前分期,与手术及病理结果对比,比较MRI和EUS对直肠肿瘤浸润深度、区域淋巴结转移判断的准确性.结果 MRI判断T分期总的准确率为76.4％ (55/72),MRI评价N分期的准确率为63.9％ (46/72),EUS判断T分期总的准确率为81.8％(45/55),评价N分期的准确率为65.5％ (36/55).结论 MRI与EUS判断T分期的准确性差异无统计学意义,EUS判断早中期直肠肿瘤浸润层次的准确率高于MRI,两者判断N分期的准确率均较低.     

A prospective comparison between multidetector-row computed tomography and magnetic resonance imaging in the preoperative evaluation of rectal carcinoma

BACKGROUND: Multidetector-row computed tomography (MDCT, or multislice CT) is a new modality with four detectors, which makes examination time shorter and produces higher resolution and multiplanar reformation of the images. Its diagnostic role in patients with rectal carcinoma has not been determined. METHODS: Twenty-one patients with rectal carcinoma were preoperatively examined by both MDCT and magnetic resonance imaging (MRI). Diagnostic accuracies of both modalities were compared regarding depth of tumor invasion and lymph node metastasis based on the pathologic findings. RESULTS: Both examinations detected all tumors. Regarding depth of tumor invasion, the concordance was 95.2% (20 of 21) for MDCT and 100% (21 of 21) for MRI. Regarding lymph node metastasis, the overall accuracy was 61.9% for MDCT and 70.0% for MRI. CONCLUSIONS: Multidetector-row computed tomography was equal to MRI in the preoperative local staging of rectal carcinoma.     

Efficacy of 3-dimensional endorectal ultrasonography compared with conventional ultrasonography and computed tomography in preoperative rectal cancer staging

BACKGROUND: This study was performed to verify reports of the decreased accuracy of endorectal ultrasonography (EUS) in preoperative staging of rectal cancer, and to compare the efficacy of 3-dimensional (3D) EUS with that of 2-dimensional (2D) EUS and computed tomography (CT). METHODS: Eighty-six consecutive rectal cancer patients undergoing curative surgery were evaluated by 2D EUS, 3D EUS, and CT scan. RESULTS: The accuracy in T-staging was 78% for 3D EUS, 69% for 2D EUS, and 57% for CT (P < .001-.002), whereas the accuracy in evaluating lymph node metastases was 65%, 56%, and 53%, respectively (P < .001-.006). Examiner errors were the most frequent cause of misinterpretation, occurring in 47% of 2D EUS examinations and in 65% of 3D EUS examinations. By eliminating examiner errors, the accuracy rates in T-staging and lymph node evaluation could be improved to 88% and 76%, respectively, for 2D EUS, and to 91% and 90%, respectively, for 3D EUS. Conical protrusions along the deep tumor border on 3D images were correlated closely with infiltration grade, advanced T-stage, and lymph node metastasis. CONCLUSIONS: We found that 3D EUS showed greater accuracy than 2D EUS or CT in rectal cancer staging and lymph node metastases. Concrete 3D images based on tumor biology appear to provide more accurate information on tumor progression.     

Preoperative Staging of Rectal Cancer With MRI: Accuracy and Clinical Usefulness

Background: Preoperative staging is essential for planning of optimal therapy for patients with rectal cancer. Recently, magnetic resonance imaging (MRI) is used frequently because of its benefits of clear pelvic image are better than other diagnostic methods. The purpose of this study was to determine accuracy rates and clinical usefulness of MRI in preoperative staging of rectal cancer.Methods: Between February, 1997, and December, 1999, 217 patients with histologically proven rectal cancer were staged preoperatively and had surgical resections performed. MRI criteria for depth of invasion was determined by the degree of disruption of the rectal wall. Metastatic perirectal lymph nodes were considered to be present if they showed heterogenous texture, irregular margin, and enlargement (.10 mm).Results: The accuracy of the MRI for determining depth of invasion was 176/217 (81%) and regional lymph node invasion was 110/217 (63%). In the T stage, accuracy rate of T1 was 3/4 (75%), T2 was 20/37 (54%), T3 was 141/162 (87%), and T4 was 12/14 (86%), respectively. The specificity of lymph node invasion was 45/110 (41%) and the sensitivity was 91/107 (85%). The accuracy rate of regional lymph node involvement was 136/217 (63%). T1 and T2 were overstaged in 1/4 (25%) and 17/37 (46%), respectively, and T3 was understaged in 15/162 (9.2%). The accuracy rate to detect metastatic lateral pelvic lymph node was 4/14 (29%) after lateral pelvic lymph node dissection was done in 14 patients under MRI. The accuracy rate in assessing levator ani muscle tumor involvement was 8/11 (72%).Conclusions: MRI showed a good, comparable accuracy rate for determining depth of tumor invasion, compared with transrectal ultrasonography, which still has a low accuracy rate for detecting metastatic lymph node. MRI with endorectal coil may increase the accuracy rate of T1 and T2 lesions. In addition, clear sagittal and coronal sectional pelvic images can give a lot of information about adjacent organ invasion or any invasion of levator ani muscle. MRI can be useful for choosing an appropriate extent of lymph node dissection and type of surgery.     

Prospective comparison of endorectal ultrasound, three-dimensional endorectal ultrasound, and endorectal MRI in the preoperative evaluation of rectal tumorsrid=""

Background: The aim of this study was to compare the value of endorectal ultrasound (EUS), three-dimensional (3D) EUS, and endorectal MRI in the preoperative staging of rectal neoplasms. Methods: Thirty consecutive patients with rectal tumors were assessed by EUS and endorectal MRI. Additionally, three-dimensional ultrasound was performed in a subgroup of 25 patients. EUS data were obtained with a bifocal multiplane transducer (10 MHz) and processed on a 3D ultrasound workstation. MR imaging was carried out with a 1.5 T superconducting unit using an endorectal surface coil. Results: EUS was carried out successfully in all 30 patients, whereas endorectal MRI was not feasible in two patients. Compared with the histopathological classification, EUS and endorectal MRI correctly determined the tumor infiltration depth in 25 of 30 and 28 patients, respectively. The comparative accuracy of EUS, 3D EUS, and endorectal MRI in predicting tumor invasion was 84%, 88%, and 91%, respectively. EUS, three-dimensional EUS, and endorectal MRI enabled us to assess the lymph node status correctly in 25, 25, and 24 patients, respectively. Both three-dimensional EUS and endorectal MRI combined high-resolution imaging and multiplanar display options. Assessment of additional scan planes facilitated the interpretation of the findings and improved the understanding of the three-dimensional anatomy. Conclusion: The accuracy of three-dimensional EUS and endorectal MRI in the assessment of the infiltration depth of rectal cancer is comparable to conventional EUS. One advantage of both methods is the ability to obtain multiplanar images, which may be helpful for the planning of surgery in the future. Received: 4 April 2000/Accepted: 25 August 2000/Online publication: 27 October 2000     

Comparison of CT and MRI in the pre-operative staging of rectal adenocarcinoma and prediction of circumferential resection margin involvement by MRI

Objective It has been suggested that MRI may be used as the sole modality of choice in pre‐operative staging in rectal cancers. Knowledge of tumour stage and a threatened Circumferential Resection Margin (CRM) pre‐operatively are essential for planning neo‐adjuvant therapy and as predictors of local recurrence. At present most units utilize CT scanning to assess these parameters. The aim of our study was two fold: firstly to examine the accuracy of preop CT and MRI staging of rectal cancers compared with final histology and secondly to assess the accuracy of MRI in predicting penetration of the mesorectal envelope (ME). Patients and methods All patients with biopsy proven rectal adenocarcinoma underwent thin slice MRI and CT scan pre‐operatively. Forty‐seven patients have been prospectively entered into the study: 24 male (median age 68 years; range 38–91 years). Eleven patients were unsuitable for surgery leaving 36 patients available for study. Results CT correctly staged patients with T1/T2 rectal cancers more often than MRI (77%vs. 43%, P = 0.226). Patients with T1/T2 tumours were overstaged more often by MRI compared with CT (54%vs. 23%, P = 0.226). A greater proportion of patients with T3 tumours were correctly staged by MRI than CT (76%vs. 41%, P = 0.08); and more T3 disease was understaged by CT than MRI (54 vs. 18%, P = 0.032). CT and MRI staged T4 disease equally. In the assessment of mesorectal envelope integrity, MRI had a sensitivity of 80% and a specificity of 84%. The positive predictive value was 44% and the negative predictive value 96%. Conclusions These results suggest significant differences between accurate pre‐operative ‘T’ staging by CT and MRI for rectal cancer. MRI has the potential however, to accurately assess mesorectal envelope invasion. Further analysis is required to assess whether MRI can be used as the sole modality in pre‐operative staging of rectal cancers.     

仿真内窥镜CT和多平面重建对直肠癌术前分期的判断

目的：探讨CT仿真内镜（CTVE）和多平面重建（MPR）对直肠癌术前分期的判断。方法：通过系统地采用CTVE和MPR与普通CT对比，对45例直肠癌患者的分期进行了评估。结果：CTVE和 MPR术前分期的准确率为86.7%（39/45），普通盆腔CT为66.7%（30/45），两者间差异有显著性（P<0.05）。有淋巴结转移的术前准确判断敏感性CTVE和 MPR为76.9%（20/26），普通盆腔CT为50.0%（13/26），但差异有显著性（P<0.05）。结论：CTVE和 MPR对直肠癌进行临床分期的准确性较普通CT高，对临床治疗具有指导意义。     

Endoscopic ultrasonography and magnetic resonance in preoperative staging of rectal cancer: Comparison with histologic findings

The development of new surgical techniques and use of neoadjuvant therapy have increased the need for accurate preoperative staging of rectal cancer. We compared the ability of endoscopic ultrasonography (EUS) and two magnetic resonance imaging (MRI) coils to locally stage rectal carcinoma before surgery. Forty-nine patients with histologically proven rectal carcinoma were T and N staged by EUS and either body coil MRI or phased-array coil MRI. After radical surgery, the preoperative findings were compared with histologic findings on the surgical specimen. For T stage, accuracies were 70% for EUS, 43% for body coil MRI, and 71% for phased-array coil MRI. For N stage, accuracies were 63% for EUS, 64% for body coil MRI, and 76% for phased-array coil MRI. For T stage, EUS had the best sensitivity (80%) and the same specificity (67%) as phased-array coil MRI. For N stage, phased-array coil MRI had the best sensitivity (63%) and the same specificity (80%) as the other methods. EUS and phased-array coil MRI provided similar results for assessing T stage. No method provided satisfactory assessments of local N stage, although phased-array coil MRI was marginally better in assessing this important parameter. Although none of the results differed significantly, phased-array coil MRI seems to be the best single method for the preoperative staging of rectal cancer. Presented at the Forty-Sixth Annual Meeting of The Society for Surgery of the Alimentary Tract, Chicago, Illinois, May 14–18, 2005 (oral presentation).     

CT、MRI对直肠癌术后局部复发的诊断及鉴别诊断

目的探讨CT及MRI在直肠癌术后局部复发中的应用现状和前景。方法收集近年来国内、外有关直肠癌术后局部复发的影像学诊断文献并作一综述。结果在直肠癌术后局部复发的诊断上,CT除了敏感性较MRI高之外,特异性和准确性都要低于MRI。CT灌注成像、动态增强MRI和弥散加权成像作为诊断直肠癌术后局部复发的新技术,具有较高的诊断价值。结论CT和MRI都是重要且有效的诊断直肠癌术后局部复发的手段。     

超声结肠镜检查在直肠肿瘤诊断中的作用

目的评价超声结肠镜(EUS)在直肠肿瘤诊断中的作用。方法应用 EUS 检查10例直肠良恶性肿瘤,将其病变所在层次和淋巴结转移情况与病理结果进行比较。结果肿瘤所在层次 EUS 与病理符合率为90％,淋巴结转移情况 EUS 检查与病理符合率为83.3％。结论 EUS 是一项对直肠病变诊断及指导选择治疗方式有用的检查手段。     

Is a preoperative multidiagnostic approach to predict surgical resectability of periampullary tumors still effective?

BACKGROUND: Multimodality staging is recommended in patients with periampullary tumors to optimize preoperative determination of resectability. We investigated the potency of currently used diagnostic procedures in order to determine resectability. METHODS: Ninety-five consecutive patients with periampullary tumors prehospitally staged resectable underwent preoperative diagnostic tests: helical-computed tomography (CT) with maximum intensity projection of arterial vessels (MIP), magnetic resonance imaging (MRI), magnetic resonance cholangiopancreaticography (MRCP), endoscopic ultrasonography (EUS), endoscopic retrograde cholangiopancreaticography (ERCP), digital subtraction angiography (DSA), and positron emission tomography (PET). Diagnoses were verified by surgery and histopathology. RESULTS: In 45 patients with benign and 50 patients with malignant periampullary tumors sensitivity for tumor diagnosis was 89% to 96% in CT, MRI, EUS, and PET. Small tumors were best diagnosed by EUS (100%). Diagnosis of malignancy was made with 85% (EUS), 83% (CT), 82% (PET), and 72% (MRI) accuracy. Arterial vessel infiltration was best predicted by CT/MIP with an accuracy of 85%. For venous vessel infiltration MRI reached 85% accuracy. Accuracy rates for local nonresectability were 93% (EUS), 92% (MRI), and 90% (CT). Two and 4 of 8 patients with distant metastases were identified by CT and PET, respectively. The correct diagnosis of malignancy and determination of resectability was made by CT in 71% and by MRI in 70%. Biliary stenting reduced accuracy of CT diagnosis of malignancy from 88% to 73%. CONCLUSIONS: CT obtained before stenting was the single most useful test, providing correct diagnosis in 88% and resectability in 71% of patients. If no tumor is depicted in CT, EUS should be added. Uncertain venous vessel infiltration can be verified by MRI or EUS. Angiography should no longer be a routine diagnostic procedure. Equivocal tumors or possible metastasis may be further examined with PET.