MRI对直肠癌新辅助放化疗后再分期的价值

发布时间：2018-05-15 21:02

本文选题：磁共振成像 + 术前放化疗　；参考：《浙江大学》2015年硕士论文

【摘要】：目的分析并评价磁共振成像(MRI)对局部进展期直肠癌新辅助放化疗(N-CRT)后再分期的准确性。资料及方法回顾性分析了94例经病理确诊的局部进展期中低位直肠非粘液性腺癌患者的临床资料,所有患者均接受了N-CRT,并且在治疗结束6-8周后进行了根治性手术,新辅助治疗前后MRI影像资料均由一位放射科专家进行阅片,并与相应的术后病理结果进行比较。计算MRI对T再分期及N再分期的准确率。用Kappa统计学分析方法检验N-CRT后MRI分期与术后病理分期的一致性。结果 N-CRT后MRd对肿瘤T分期的诊断准确率为49%,分别有40.4%T分期过高和10.6%T分期过低。达到病理完全缓解(pCR)的患者,只有18%在术前MRI上得到准确的预测,但是我们发现MRI预测pCR的特异性值为100%。N-CRT后MRI对N分期诊断准确率为63.8%,其中有26.6%N分期过高,9.6%N分期过低。Kappa分析结果显示,N-CRT后MRI分期与术后病理分期的一致性较差,T分期：K=0.156,N分期：K=0.289。结论直肠癌N-CRT后MRI分期的诊断准确率较低,如何提高术前分期的诊断水平仍是一个挑战,临床迫切需要一种更准确的技术方法。鉴于MRI判断pCR的特异性非常高,在遵循目前治疗规范的前提下,对于那些达到pCR但又不能耐受或是拒绝手术的患者,可考虑选择密切临床随访。
[Abstract]:Purpose To evaluate the accuracy of magnetic resonance imaging (MRI) in staging neoadjuvant chemotherapy and neoadjuvant chemotherapy of locally advanced rectal cancer after N-CRT. Data and methods The clinical data of 94 pathologically diagnosed patients with locally advanced non-mucinous rectal adenocarcinoma were retrospectively analyzed. All patients received N-CRT and underwent radical surgery 6-8 weeks after treatment. Before and after neo-adjuvant therapy, MRI images were read by a radiologist and compared with the corresponding postoperative pathological results. The accuracy of MRI in T and N stages was calculated. Kappa statistical analysis was used to examine the consistency between MRI staging and postoperative pathological staging after N-CRT. Result The diagnostic accuracy of T stage after N-CRT by MRd was 49. There were 40.4 T stage and 10.6 T stage too low respectively. Only 18% of patients with complete pathological remission were accurately predicted on preoperative MRI. However, we found that the specificity of MRI in predicting pCR was 63.8% for MRI after 100%.N-CRT. Among them, 26.6N stage was too high and 9.6N stage was too low. The results of Kappa analysis showed that the consistency of MRI stage after N-CRT and postoperative pathological stage was poor. Conclusion The diagnostic accuracy of MRI staging in rectal cancer after N-CRT is low. How to improve the diagnostic level of preoperative staging is still a challenge. A more accurate technical method is urgently needed in clinic. Since the specificity of MRI in judging pCR is very high, in accordance with the current treatment standards, for those who have reached pCR but can not tolerate or refuse surgery, we can consider the choice of close clinical follow-up.
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.37

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