直肠癌离体标本MRI淋巴结转移征象的病理对照研究

目的总结直肠癌离体标本在高分辨率MR结合DWI上的转移征象,探讨MRI对淋巴结良恶性判断的准确性。材料与方法通过对14例经病理证实为直肠癌并接受全直肠系膜切除术患者的术后标本行高分辨率MR及DWI检查,与病理学结果行对照分析,分析转移淋巴结的高分辨率MRI征象及DWI参数特点。结果14例直肠癌患者术后标本MRI共检出淋巴结112枚,术后病理检查发现转移淋巴结22枚,反应性增生淋巴结36枚,正常淋巴结53枚。与良性淋巴结相比,大多数转移淋巴结边缘多毛糙,其内部信号欠均匀;差异有统计学意义(P0.05);反应性增生淋巴结和转移淋巴结短径分别为0.47~0.96 cm、0.52~0.96cm,均大于正常淋巴结(0.25~0.72 cm),差异有统计学意义(P0.05),但两者之间差异没有统计学意义(P0.05);其短径与长径之比分别为0.855±0.047、0.0273±0.006,差异有统计学意义(P0.05)。转移性淋巴结的ADC值明显低于正常淋巴结(0.722±0.047)×10~(–3) mm~2/s∶(0..868±0.064)×10~(–3) mm~2/s],但是与反应性增生淋巴结(0.734±0.078)×10~(–3) mm~2/s之间没有明显差异。结论高分辨率MRI对直肠癌系膜内淋巴结的边缘及内部信号特征的显示清楚,对转移淋巴结转移评价具有较高的诊断价值,DWI对区分正常淋巴结与转移淋巴结有一定的价值,但对于鉴别反应性增生淋巴结与转移淋巴结意义不大。

Specimens of colorectal cancer in vitro MRI pathological control study for signs of lymph node metastasis

Objective:To summarize the metastasis signs of rectal cancer lymph node on high resolution MR and DWI, to explore the accuracy of MRI examination of benignandmalignantlymphnode.Materials and Methods:Fourteenpatientswho confirmed as rectal cancer by pathology and accepted total mesentery excision rectal cancer were included in the study, and their specimens were examined by high-resolution MRI and DWI. Then according to the pathological examination, analyze the high-resolution MRI manifestations and DWI parameters characteristics of metastasis lymph node. Results:There are 14 patients with rectal cancer were concluded in the study, specimens MRI detected 112 lymph node and postoperative pathology examination found metastasis lymph nodes 22, reactive lymph nodes 36, normal lymph node 53. Most metastasis lymph node is neither smooth edge, no uniform internal signals, compared with benign lymph nodes, the difference was statistically significant (P<0.05). Most metastasis lymph node is neither smooth edge, no uniform internal signals, compared with benign lymph nodes, the difference was statistically significant, P values were less than 0.05. The short diameter of reactive hyperplastic lymph node and metastasis lymph nodes are 0.47—0.96 cm, 0.52—0.96 cm respectively, they are greater than normal lymph nodes (0.25—0.72 cm), the difference was statistically significant (P<0.05), but the difference between the reactive hyperplastic lymph node and metastasis lymph nodes has no statistical significance (P>0.05). The ratio of short diameter and length diameter are 0.855±0.047 and 0.0273±0.006, the difference was statistically significant (P<0.05). The ADC values of metastatic lymph nodes is markedly lower than the normal lymph nodes (0.722±0.047)×10–3 mm2/s:(0.868±0.064)×10–3 mm2/s], but with reactive hyperplastic lymph node (0.734±0.078)×10–3 mm2/s was no significant difference. Conclusions:The edge and internal signal of the lymph node within the rectal mesentery displayed clearly on high-resolution magnetic resonance imaging (MRI), it has high diagnostic value for the assessment of metastasis lymph node metastasis. DWI for distinguishing normal lymph nodes with metastasis lymph node has certain value, but to identify reactive hyperplastic lymph nodes with metastasis lymph nodes, it has no significant means.