直肠癌MRI与肠镜对照及与病理的相关性研究
发布时间：2018-09-08 15:25
【摘要】：目的 1、应用高分辨磁共振成像观察直肠肠壁及其周围解剖细节，总结其磁共振表现及信号特点；评价重要解剖结构的显示率，为部分解剖结构提供影像学依据。 2、探讨HR-MRI、DWI序列对直肠癌术前T、N分期的价值;探讨直肠癌MRI、肠镜分型与MVD的关系及ADC值与MVD的相关性。 材料和方法 应用德国SIMENS公司1.5T Avanto型磁共振扫描仪，8通道线圈。收集80名正常人的盆腔多序列参数MR图像，两位高年资医师共同阅片,统计其中60例图像质量较好,肠道伪影较少的直肠固有筋膜的前、后、左、右侧的显示率，以及Denonvillier，s筋膜、骶前筋膜、骶骨筋膜、腹膜返折、下腹下丛及直肠侧韧带的显示率。观察正常直肠壁各层结构在不同磁共振序列上的信号特点。 两位高年资医师回顾性分析28例直肠癌患者MR资料，以三组不同序列组合对病例进行术前TN分期。第一组单独使用常规序列，第二组常规序列结合HR-MRI，第三组常规序列结合HR-MRI和DWI，同时获得ADC图，避开液化坏死区域，测得相应的ADC值，三次测量后取平均值。各组术前MRI的分期分别与术后病理T、N分期比较，得出各组MR分期的正确率、灵敏度、特异度、阳性预测值和阴性预测值、与病理分期一致性以及N分期约登指数。在MRI正中矢状面图像中取肿瘤与肛缘所切的最佳层面图像，以肿瘤最下缘作为直肠癌病灶的下缘，沿直肠的曲度至肛缘做曲线并测量其长度，与肠镜测量结果比较。 所有病例术前行肠镜检查，观察并记录肠镜表现。术后标本切片进行HE染色及CD34单克隆抗体SP法免疫组织化染色，计数400倍光镜下5个视野内微血管数，取平均值作为MVD值。统计MR分期、是否强化及肠镜分型与MVD的关系及ADC值与MVD的相关性，ADC与MVD的相关性采用Spearman相关分析，不同分组病灶下缘距肛缘的距离及MVD值以均数±标准差（x±s）表示。采用t检验，P＜0.05，差异有统计学意义。 结果 1、高分辨磁共振可以清楚地显示直肠壁的黏膜层、黏膜下层和固有肌层；直肠固有筋膜前、后、左、右侧的显示率分别为71.7%(43/60)，96.7%(58/60)，90.0%(54/60),93.3%(56/60)。Denonvillier，s筋膜、骶前筋膜、直肠骶骨筋膜、腹膜返折及下腹下丛的显示率分别为68.3%（41/60）、65.0%（39/60）、86.6%（52/60）、86.3%（51/60）和90.0%（54/60），直肠侧韧带的显示率较低，左侧为53.3%（32/60），右侧为46.7%（28/60）。 2、收集28例直肠癌患者MR图像，第一组T分期总的准确率为71.4%（20/28），，Kappa=0.609，与病理术后结果的一致性一般。第二、三组T分期总的准确率都为85.7%（24/28），Kappa=0.805，与病理术后结果的一致性较好。N分期中，第一组正确诊断的有20例，Kappa=0.440，登指数为0.542；第二组正确诊断的为21例，Kappa=0.505，约登指数为0.770；第三组正确诊断的为23例，Kappa=0.632约登指数为0.625。三组方法与术后病理结果N分期一致性均一般。 3、MRI测量病灶下缘距肛缘的距离与肠镜测量结果比较，P0.05，差异无统计学意义。MR分期中T3-4期的MVD值为27.00±4.34较T1-2期20.47±3.60高，N1-2期为26.35±4.06较N0期19.09±2.98高，P0.05，差异有统计学意义。直肠癌MVD值在MRI增强扫描有、无强化及肠镜不同分型之间进行对照，P0.05,差异无统计学意义。ADC与MVD呈负相关(r=-0.743，P 0.05)。 结论 1、高分辨磁共振可以辨识直肠肠壁及周围解剖细节，判断邻近组织是否受侵，为MRI术前分期提供理论基础；为部分解剖结构提供影像学依据。 2、HR-MRI和DWI在直肠癌T、N分期方面具有重要意义，MRI常规序列结合HR-MRI可以明显提高直肠癌术前T分期的准确性，与病理T分期比较具有较高的一致性。DWI虽不能提高T分期准确性，但在N分期中可以提高可疑淋巴结的检出率，约登指数以常规序列结合HR-MR序列最高。 3、磁共振可准确的测量病灶下缘距肛门的距离。MR分期与ADC值对肿瘤中微血管密度具有术前提示作用，间接反映直肠癌的病程进展，为临床治疗及判断预后提供更多更有价值的参考指标。
[Abstract]:objective
1. Applying high resolution magnetic resonance imaging to observe the anatomical details of rectal intestinal wall and its surroundings, summarize its MRI manifestations and signal characteristics, evaluate the display rate of important anatomical structures, and provide imaging basis for some anatomical structures.
2. To explore the value of HR-MRI and DWI sequences in preoperative T and N staging of rectal cancer, and to explore the relationship between MRI and Enteroscopic typing of rectal cancer and MVD, and the correlation between ADC value and MVD.
Materials and methods
Using the 1.5T Avanto MR scanner made by SIMENS, Germany, 8-channel coils, 80 normal pelvic multi-sequence parameters MR images were collected and read by two senior physicians. The images of 60 cases with good quality and fewer intestinal artifacts were statistically analyzed. Anterior fascia, sacral fascia, peritoneal reflex, inferior epigastric plexus and lateral rectal ligament were detected.
Two senior physicians retrospectively analyzed the MR data of 28 patients with rectal cancer and performed preoperative TN staging in three groups of different sequence combinations. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value, consistency with pathological staging and the Jordan index of N staging were obtained by comparing preoperative MRI staging with postoperative pathological T and N staging. The lower edge of the tumor was taken as the lower edge of the rectal cancer lesion. The curve was made along the rectal curvature to the anal edge and its length was measured. The results were compared with those obtained by colonoscopy.
All cases were examined by colonoscopy before operation and their colonoscopic manifestations were observed and recorded. After operation, specimens were stained with HE and immunohistochemical staining with CD34 monoclonal antibody SP method. The number of microvasculature in five visual fields under 400-fold light microscope was counted. The MVD value was taken as the mean value. The relationship between MVD and MR staging, enhancement and colonoscopy typing, and the correlation between ADC value and MVD were analyzed. Spearman correlation analysis was used to analyze the correlation between ADC and MVD. The distances from the inferior margin of the lesions to the anal margin and MVD values were expressed as mean (+ standard deviation) in different groups.
Result
1. High-resolution magnetic resonance imaging can clearly show the mucosa, submucosa and muscularis propria of the rectal wall. Before, after, left and right rectal proper fascia, the display rates were 71.7% (43/60), 96.7% (58/60), 90.0% (54/60), 93.3% (56/60), respectively. 68.3% (41/60), 65.0% (39/60), 86.6% (52/60), 86.3% (51/60) and 90.0% (54/60), respectively. The display rate of the lateral rectal ligament was low, with 53.3% (32/60) on the left side and 46.7% (28/60) on the right side.
2. The total accuracy of T staging was 71.4% (20/28) and Kappa = 0.609 in the first group, which was generally consistent with the results of pathological operation. Secondly, the overall accuracy of T staging in the three groups was 85.7% (24/28) and Kappa = 0.805, which was in good agreement with the results of pathological operation. In the second group, 21 cases were correctly diagnosed, Kappa = 0.505 and Yorden index was 0.770. In the third group, 23 cases were correctly diagnosed and Kappa = 0.632 Yorden index was 0.625.
There was no significant difference between the distances from the inferior margin of the lesion to the anal margin measured by MRI and those measured by colonoscopy (P 0.05). MVD values of T3-4 in MR staging were 27.00+4.34 higher than that of T1-2 stage (20.47+3.60), 26.35+4.06 higher than that of N0 stage (19.09+2.98) and P 0.05, respectively. There was no significant difference in P0.05 between the same genotypes. There was no significant difference between.ADC and MVD (r=-0.743, P 0.05).
conclusion
1. High-resolution magnetic resonance imaging can identify the anatomical details of the rectal intestinal wall and its surrounding tissues, judge whether the adjacent tissues are invaded, and provide theoretical basis for preoperative staging of MRI, and provide imaging basis for some anatomical structures.
2. HR-MRI and DWI are of great significance in T and N staging of rectal cancer. Conventional sequence of MRI combined with HR-MRI can significantly improve the accuracy of preoperative T staging of rectal cancer and have a higher consistency with pathological T staging. DWI can not improve the accuracy of T staging, but it can improve the detection rate of suspicious lymph nodes in N staging, and the Yoden index can be routinely used. Sequence combined with HR-MR sequence was the highest.
3. Magnetic resonance imaging can accurately measure the distances from the lower edge of the lesion to the anus. The staging of MR and ADC values can indicate the microvessel density in the tumor before operation, indirectly reflect the progression of rectal cancer, and provide more valuable references for clinical treatment and prognosis.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R735.37;R445.2
本文编号：2230919
[Abstract]:objective
1. Applying high resolution magnetic resonance imaging to observe the anatomical details of rectal intestinal wall and its surroundings, summarize its MRI manifestations and signal characteristics, evaluate the display rate of important anatomical structures, and provide imaging basis for some anatomical structures.
2. To explore the value of HR-MRI and DWI sequences in preoperative T and N staging of rectal cancer, and to explore the relationship between MRI and Enteroscopic typing of rectal cancer and MVD, and the correlation between ADC value and MVD.
Materials and methods
Using the 1.5T Avanto MR scanner made by SIMENS, Germany, 8-channel coils, 80 normal pelvic multi-sequence parameters MR images were collected and read by two senior physicians. The images of 60 cases with good quality and fewer intestinal artifacts were statistically analyzed. Anterior fascia, sacral fascia, peritoneal reflex, inferior epigastric plexus and lateral rectal ligament were detected.
Two senior physicians retrospectively analyzed the MR data of 28 patients with rectal cancer and performed preoperative TN staging in three groups of different sequence combinations. The accuracy, sensitivity, specificity, positive predictive value, negative predictive value, consistency with pathological staging and the Jordan index of N staging were obtained by comparing preoperative MRI staging with postoperative pathological T and N staging. The lower edge of the tumor was taken as the lower edge of the rectal cancer lesion. The curve was made along the rectal curvature to the anal edge and its length was measured. The results were compared with those obtained by colonoscopy.
All cases were examined by colonoscopy before operation and their colonoscopic manifestations were observed and recorded. After operation, specimens were stained with HE and immunohistochemical staining with CD34 monoclonal antibody SP method. The number of microvasculature in five visual fields under 400-fold light microscope was counted. The MVD value was taken as the mean value. The relationship between MVD and MR staging, enhancement and colonoscopy typing, and the correlation between ADC value and MVD were analyzed. Spearman correlation analysis was used to analyze the correlation between ADC and MVD. The distances from the inferior margin of the lesions to the anal margin and MVD values were expressed as mean (+ standard deviation) in different groups.
Result
1. High-resolution magnetic resonance imaging can clearly show the mucosa, submucosa and muscularis propria of the rectal wall. Before, after, left and right rectal proper fascia, the display rates were 71.7% (43/60), 96.7% (58/60), 90.0% (54/60), 93.3% (56/60), respectively. 68.3% (41/60), 65.0% (39/60), 86.6% (52/60), 86.3% (51/60) and 90.0% (54/60), respectively. The display rate of the lateral rectal ligament was low, with 53.3% (32/60) on the left side and 46.7% (28/60) on the right side.
2. The total accuracy of T staging was 71.4% (20/28) and Kappa = 0.609 in the first group, which was generally consistent with the results of pathological operation. Secondly, the overall accuracy of T staging in the three groups was 85.7% (24/28) and Kappa = 0.805, which was in good agreement with the results of pathological operation. In the second group, 21 cases were correctly diagnosed, Kappa = 0.505 and Yorden index was 0.770. In the third group, 23 cases were correctly diagnosed and Kappa = 0.632 Yorden index was 0.625.
There was no significant difference between the distances from the inferior margin of the lesion to the anal margin measured by MRI and those measured by colonoscopy (P 0.05). MVD values of T3-4 in MR staging were 27.00+4.34 higher than that of T1-2 stage (20.47+3.60), 26.35+4.06 higher than that of N0 stage (19.09+2.98) and P 0.05, respectively. There was no significant difference in P0.05 between the same genotypes. There was no significant difference between.ADC and MVD (r=-0.743, P 0.05).
conclusion
1. High-resolution magnetic resonance imaging can identify the anatomical details of the rectal intestinal wall and its surrounding tissues, judge whether the adjacent tissues are invaded, and provide theoretical basis for preoperative staging of MRI, and provide imaging basis for some anatomical structures.
2. HR-MRI and DWI are of great significance in T and N staging of rectal cancer. Conventional sequence of MRI combined with HR-MRI can significantly improve the accuracy of preoperative T staging of rectal cancer and have a higher consistency with pathological T staging. DWI can not improve the accuracy of T staging, but it can improve the detection rate of suspicious lymph nodes in N staging, and the Yoden index can be routinely used. Sequence combined with HR-MR sequence was the highest.
3. Magnetic resonance imaging can accurately measure the distances from the lower edge of the lesion to the anus. The staging of MR and ADC values can indicate the microvessel density in the tumor before operation, indirectly reflect the progression of rectal cancer, and provide more valuable references for clinical treatment and prognosis.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R735.37;R445.2
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