空气对比剂灌肠MR结肠成像在结直肠癌中的应用研究
发布时间：2018-11-17 18:28
【摘要】：目的 1、评估空气对比剂灌肠MR结肠成像的可行性和成像质量； 2、评估MR结肠成像对结直肠肿块检出的敏感性； 3、对结直肠癌进行术前分期。 材料和方法 搜集我院2012年7月～2014年3月因为粪便隐血实验阳性、排便性状改变、腹部包块等疑似结直肠癌患者30例(其中男19例,女11例,年龄21-78岁,中位年龄52岁)。所有患者均没有MR检查的禁忌症,并且都经纤维结肠镜和病理证实。 患者均在检查前一天进流质饮食并进行肠道准备,检查前10min肌肉注射丁溴东莨菪碱(解痉灵)20mmg,经直肠导管注入空气1000-1300ml后开始扫描。采用SSFSE和FIESTA序列在一次屏气时冠状位扫描全部结直肠图像,对疑似病变部位进行T1WI、T2WI和DWI序列横轴位扫描,直肠病变时加扫矢状位。观察患者的耐受性,分析肠道准备质量和MR结直肠图像质量。在纤维结肠镜和手术病理对照下,计算结直肠肿块检出的敏感性和结直肠癌术前分期的准确性。 结果 1、MR结肠成像的可行性与成像质量 使用空气作为对比剂灌肠安全并且没有成本,所有患者均完成MR结肠成像检查,在检查期间仅有腹胀感,但在检查结束后的24小时内没有不适感和其他并发症。共得到240个肠段图像,准备良好的肠段为80.83%(194/240),1级扩张肠段为77.08%(185/240)。升结肠、结肠肝曲、横结肠和结肠脾曲扩张程度优于盲肠、降结肠、乙状结肠和直肠,经卡方检验二者差异有显著性(χ2=5.03,P0.05)。图像中肠段伪影最少的是盲肠和直肠各1段(3.33%),最多的则集中在结肠肝曲和横结肠各4段(13.33%)。 2、结直肠肿块检查敏感性 与纤维结肠镜和病理结果对照比较,空气灌肠MR结肠成像对肿块检出的敏感性为：大于10mm肿块检出敏感度为91.42%(32/35),5～10mm肿块检出敏感度66.67%(6/9),小于5mm的病变仅检出1个(1/3)。 3、结直肠癌术前分期 25个结直肠癌病灶均定位定性准确,MR结肠成像TNM分期准确性为76.67%(23/30)。T分期总的准确率为83.33%(25/30),其中：≤T2期分期准确性为80%(8/10),T3期分期准确性为83.33%(15/18),T4期分期准确性为100%(2/2)。肿瘤浆膜外侵犯的敏感度为85%(17/20),特异度为80%(8/10)。N分期总的准确性为76.67%(23/30),其中：NO期分期准确性为78.58%(11/14),N1期分期准确性为75%(9/12),N2期分期准确性为75%(3/4)。淋巴结转移的敏感度为81.25%(13/16),特异度为78.58%(11/14)。M分期总检出率为80%(4/5),MR结肠成像发现了肝脏转移灶4例,但1例后腹膜转移未检出。 结论 ①空气是一种安全、无成本的对比剂,患者接受度高,基本无不良反应。 ②空气对比剂灌肠MR结肠成像肠道扩张程度好,软组织分辨率高并且没有电离辐射,对结直肠肿块的检测是一种有吸引力和潜力的影像学方法。 ③空气对比剂灌肠MR结肠成像对结直肠癌术前分期准确,能评估肿瘤浆膜外侵犯、淋巴结和远端器官的转移。
[Abstract]:Objective 1, to evaluate the feasibility and imaging quality of air contrast agent enema MR colon imaging; 2, to evaluate the sensitivity of MR colon imaging to the detection of colorectal masses; 3, to staging colorectal cancer before operation. Materials and methods from July 2012 to March 2014, 30 patients (19 males and 11 females, aged 21-78 years) with suspected colorectal cancer, including 19 males and 11 females, were collected in our hospital as a result of fecal occult blood test positive, defecation character change, abdominal mass and other suspected colorectal cancer patients. The median age is 52. All patients had no contraindication for MR examination and were confirmed by fibrocolonoscopy and pathology. 10min was injected intramuscularly with butadimine scopolamine (Anisodamine) 20mmg and then scanned by transrectal catheter injection of air 1000-1300ml. SSFSE and FIESTA sequences were used to scan all the colorectal images at a time of breath holding. The suspected lesions were scanned on T1WI T2WI and DWI sequences on transverse axis, and on sagittal scan on rectal lesions. The tolerance of patients was observed and the quality of bowel preparation and MR colorectal images were analyzed. The sensitivity of detection of colorectal masses and the accuracy of preoperative staging of colorectal cancer were calculated by fibercolonoscopy and surgery and pathology. Results 1 the feasibility and quality of Mr colon imaging with air as contrast medium enema was safe and cost free. All patients completed MR colonic imaging and had only abdominal distention during the examination. However, there was no discomfort or other complications within 24 hours after the examination. A total of 240 segment images were obtained. The number of well prepared segments was 80.83% (194-240), and that of grade 1 dilatation was 77.08% (1855 / 240). The degree of dilatation of ascending colon, hepatic flexure of colon, transverse colon and splenic flexure of colon was better than that of caecum, descending colon, sigmoid colon and rectum. There was significant difference between them by chi-square test (蠂 2 + 5.03% P 0.05). One segment of cecum and one segment of rectum (3.33%) were the least artifact of midgut segment, and the most frequently occurred in 4 segments (13.33%) of hepatic flexure of colon and 4 segment of transverse colon (13.33%). 2Compared with the results of fibercolonoscopy and pathology, the sensitivity of air enema MR colon imaging was 91.42% (32 / 35) higher than that of 10mm. The sensitivity of 5~10mm was 66.67% (6 / 9), only 1 (1 / 3) of 5mm was detected. 3. All 25 lesions in preoperative staging of colorectal cancer were localized and qualitatively accurate. The accuracy of MR colonic imaging TNM staging was 76.67% (23 / 30). T), and the overall accuracy was 83.33% (25 / 30). The accuracy of stages 鈮，
本文编号：2338700
[Abstract]:Objective 1, to evaluate the feasibility and imaging quality of air contrast agent enema MR colon imaging; 2, to evaluate the sensitivity of MR colon imaging to the detection of colorectal masses; 3, to staging colorectal cancer before operation. Materials and methods from July 2012 to March 2014, 30 patients (19 males and 11 females, aged 21-78 years) with suspected colorectal cancer, including 19 males and 11 females, were collected in our hospital as a result of fecal occult blood test positive, defecation character change, abdominal mass and other suspected colorectal cancer patients. The median age is 52. All patients had no contraindication for MR examination and were confirmed by fibrocolonoscopy and pathology. 10min was injected intramuscularly with butadimine scopolamine (Anisodamine) 20mmg and then scanned by transrectal catheter injection of air 1000-1300ml. SSFSE and FIESTA sequences were used to scan all the colorectal images at a time of breath holding. The suspected lesions were scanned on T1WI T2WI and DWI sequences on transverse axis, and on sagittal scan on rectal lesions. The tolerance of patients was observed and the quality of bowel preparation and MR colorectal images were analyzed. The sensitivity of detection of colorectal masses and the accuracy of preoperative staging of colorectal cancer were calculated by fibercolonoscopy and surgery and pathology. Results 1 the feasibility and quality of Mr colon imaging with air as contrast medium enema was safe and cost free. All patients completed MR colonic imaging and had only abdominal distention during the examination. However, there was no discomfort or other complications within 24 hours after the examination. A total of 240 segment images were obtained. The number of well prepared segments was 80.83% (194-240), and that of grade 1 dilatation was 77.08% (1855 / 240). The degree of dilatation of ascending colon, hepatic flexure of colon, transverse colon and splenic flexure of colon was better than that of caecum, descending colon, sigmoid colon and rectum. There was significant difference between them by chi-square test (蠂 2 + 5.03% P 0.05). One segment of cecum and one segment of rectum (3.33%) were the least artifact of midgut segment, and the most frequently occurred in 4 segments (13.33%) of hepatic flexure of colon and 4 segment of transverse colon (13.33%). 2Compared with the results of fibercolonoscopy and pathology, the sensitivity of air enema MR colon imaging was 91.42% (32 / 35) higher than that of 10mm. The sensitivity of 5~10mm was 66.67% (6 / 9), only 1 (1 / 3) of 5mm was detected. 3. All 25 lesions in preoperative staging of colorectal cancer were localized and qualitatively accurate. The accuracy of MR colonic imaging TNM staging was 76.67% (23 / 30). T), and the overall accuracy was 83.33% (25 / 30). The accuracy of stages 鈮，
本文编号：2338700
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