结直肠肿瘤MRI的临床价值

目的探讨磁共振成像(m agnetic resonance im aging,MR I)在结直肠肿瘤术前分期方面的临床价值。方法通过对38例临床诊断为原发性结直肠肿瘤的病例应用相控阵表面线圈对结直肠肿瘤进行术前的MR I检查,应用T1 FSE,T2 FRFSE或T2 FATSAT FRFSE序列,在肿瘤的局部浸润,淋巴结转移方面与术后的病理结果进行对照,对肠壁肿瘤浸润及肠周淋巴结转移情况进行评价。结果在结肠癌MR I对T1~T2期的诊断准确率为85.7%(6/7),对T3,T4期的诊断准确率为100%,总体在结肠癌的诊断准确率为92.3%(12/13),过诊率7.7%(1/13);在直肠癌MR I对T1~T2期的诊断准确率为80%(8/10),对T3,T4期的诊断准确率为100%,总体在直肠癌的诊断准确率为91.3%(21/23),过诊率8.7%(2/23)。在结直肠癌的总体诊断准确率91.7%(33/36),过诊率8.3%(3/36)。MR I对结直肠癌的周围淋巴结转移的评价,其敏感度为73.68%(14/19),特异度为70.59%(12/17),准确度为72.22%(26/36)。结论MR I对结直肠肿瘤的部位和侵犯程度及区域淋巴结情况可作较为全面的评价,对于肠壁肿瘤浸润评判有较高的准确率,对周围淋巴结转移的评判准确率有待进一步提高。

The Clinical Value of Magnetic Resonance Imaging in Colorectal Tumor

Objective To study the clinical value of magnetic resonance imaging in preoperative diagnosis of colorectal tumor,together with information such as the depth of tumor invasion and lymph node metastasis.Methods 38 colorectal neoplasm cases underwent MRI with a body coil.36 of them then received operation,and histopathological examinations were also investigated.The MRI results were compared with the operative and histopathological findings,and their correlationship was analyzed.Results 36 cases were pathologically proved as colorectal carcinoma.In 13 cases of colon carcinoma,the accuracy of MRI in T1-T2 stage was 85.7%,in T3 and T4 stage,it was 100%.So the accuracy of MRI in T stage in colon carcinoma was 92.3% and overstaging rate was 7.7%.In 23 cases of rectal carcinoma,the accuracy of MRI in T1-T2 stage was 80.0%,in T3 and T4 stage,it was 100%.So the accuracy of MRI in T stage in rectal carcinoma was 91.3%,and overstaging rate was 8.7%.Overall the MRI showed a 91.7% in accuracy for colorectal wall infiltration and overstaging rate was 8.3%.In the assessment of local lymph node involvement,the MRI results were also compared with the histopathological findings,and it was found that the sensitivity for lymph node metastases in MRI was 73.68%,the specificity was 70.59% and the accuracy was 72.22%.Conclusion MRI can clearly show the wall invasion in colorectal carcinoma,and can also partly show the lymph node infiltration,but the accuracy of lymph node involvement needs further improvement.