高分辨率MRI在原发性直肠癌术前分期中的应用价值
发布时间：2018-07-28 17:00
【摘要】：背景与目的在世界范围内,直肠癌都是医学诊治中最常见的恶性消化道肿瘤之一。近年来,医生的手术方式在条件允许下倾向于选择直肠全系膜切除术(total mesorectal excision),也称为TME手术——该手术通过切除完整的直肠系膜来有效降低直肠癌术后局部复发率。但是当环周切缘(circumferential resection margin,CRM)阳性,即癌肿浸润到或穿透直肠固有筋膜,TME原则也就失去了其价值。因此,通过磁共振连续切片(冠状面)的方法,观察完整直肠癌肿及系膜的边界切缘是否有肿瘤侵犯,是评价直肠全系膜切除术手术效果的重要指标。研究证实,新辅助放化疗利于直肠肿瘤的完整切除,增加患者的保肛的机会以及降低患者的局部复发风险,其中约20%左右的患者能获得病理完全缓解(pathologic complete response,p CR)[1,2]。目前肿瘤治疗的发展方向是个体化治疗,对直肠癌患者进行准确术前分期以筛选出需要新辅助放化疗的患者以及可以直接手术的患者至关重要。术前利用高分辨率磁共振成像(High Resolution MRI,HR-MRI)的较为清晰地显示直肠壁的层次的能力来对直肠癌患者进行较为精确的分期就显得尤为重要,因为这决定患者的个体化的治疗策略。本课题分析并评价高分辨率MRI在评估直肠肿瘤患者环周切缘以及术前分期中的价值。方法前瞻性地分析40名原发性直肠癌患者,26男,14女,平均年龄52.3岁,范围32~74岁,所有患者的术前肠镜病理均显示为直肠腺癌,均签署相关知情同意书,于术前行高分辨率磁共振检查,请2位放射科医师阅片并分析评估所有患者的MRI-T分期、N分期、CRM状态及直肠系膜筋膜状态后将其与患者手术后的病理结果进行比较并分别计算相关预测指标的准确度、敏感度、特异度、阳性预测值(Positive Predictive Value,PPV)及阴性预测值(negative predictive value,NPV)。术前及术后直肠癌分期标准来自第7版《AJCC癌症分期手册》。结果1)患者中有25位肿瘤位于上段直肠(62.5%),7例患者肿瘤位于中段直肠(17.5%),8例患者肿瘤位于远端直肠(20.0%);2)基于MRI的术前T分期预测的敏感性(sensitivity)、特异性(specificity)、阳性预测值(PPV)及阴性预测值(NPV)分别为95.8%,87.5%,92%和93.3%(Kappa=0.84,P0.05);基于MRI的环周切缘(CRM)预测敏感性(sensitivity)、特异性(specificity)、阳性预测值(PPV)及阴性预测值(NPV)分别为90%,96.7%,90%和96.7%(Kappa=0.61,P0.05);MRI-N分期预测的准确度(accuracy)、敏感性(sensitivity)、特异性(specificity)、阳性预测值(PPV)及阴性预测值(NPV)分别为85%、73.3%、92%、84.6%及96.7%(Kappa=0.44,P0.05)。结论医生可以通过高分辨率MRI来有效地评估直肠癌患者的直肠系膜筋膜以及环周切缘,而这两者是影响患者手术效果的重要因素,从而精确制定患者的个体化治疗方案。
[Abstract]:Background & objective rectal cancer is one of the most common malignant digestive tract tumors in medical diagnosis and treatment worldwide. In recent years, doctors have tended to choose (total mesorectal excision), also known as TME surgery, for rectal cancer under conditions permitting-this procedure can effectively reduce the local recurrence rate of rectal cancer by removing complete mesorectum. But when the circumferential margin (circumferential resection is positive, that is, the cancer infiltrates or penetrates the proper fascia of the rectum, the TME principle also loses its value. Therefore, it is an important index to evaluate the effect of total mesorectal resection by means of continuous section (coronal plane) of magnetic resonance (MRI) to observe the tumor invasion at the margin of mesentery and complete rectal cancer. Neoadjuvant chemotherapy is beneficial to complete resection of rectal tumors, increase the chance of anal preservation and reduce the risk of local recurrence. About 20% of the patients can obtain complete pathological remission of (pathologic complete responsep CR (12 / 2). At present, the development direction of tumor therapy is individualized treatment. It is very important to select the patients who need neoadjuvant radiotherapy and chemotherapy and those who can be operated directly. It is very important to use (High Resolution MRI HR-MRI (high resolution magnetic resonance imaging) to clearly display the level of rectal wall in order to stage rectal cancer patients accurately, because this determines the individual treatment strategy of patients with rectal cancer. The purpose of this study was to analyze and evaluate the value of high resolution MRI in the evaluation of peri-circumferential margin and preoperative staging of rectal neoplasms. Methods Forty patients with primary rectal cancer were analyzed prospectively, with an average age of 52.3 years and a range of 32 to 74 years. All the patients were diagnosed as rectal adenocarcinoma by endoscopy, and all of them signed the relevant informed consent. High resolution magnetic resonance imaging was performed before operation. Two radiologists were asked to read the films and analyze and evaluate the MRI-T staging status and mesenteric fascia status of all patients. After comparing the results with the pathological results of the patients after surgery, the accuracy and sensitivity of the related predictors were calculated, respectively. Specificity, positive predictive value (Positive Predictive) and negative predictive value (negative predictive value). The preoperative and postoperative staging criteria for rectal cancer were derived from the 7th edition of the AJCC Cancer staging Manual. Results 1) 25 patients were located in the upper rectum (62.5%), 7 patients were located in the middle rectum (17.5%), 8 patients were located in the distal rectum (20.0%) the predictive value of sensitive (sensitivity), specific (specificity), positive value based on MRI for preoperative T staging was (PPV) and negative. The predictive value of sex (NPV) was 95.2% and 93.3% respectively (Kappa 0.84%), the predictive value of (sensitivity), specific (specificity), positive predictive value of circumferential margin (CRM) based on MRI and negative predictive value of (PPV) were 96.7% and 96.7% (Kappa 0.61P0.05) respectively, and the accuracy of (accuracy), sensitive (sensitivity), (specificity), positive predictive value of MRI-N staging was 96.7% and 96.7% respectively (Kappa 0.61P0.05), and the predictive value of (sensitivity), specific (specificity), positive predictive value and negative predictive value of circumferential (CRM) based on MRI were 96.7% and 96.7% (Kappa 0.61P0.05) respectively. The values of (PPV) and (NPV) were 84.6% and 96.7% respectively (P 0.05). Conclusion High resolution MRI can be used to evaluate the mesenteric fascia and circumferential margin of rectal cancer effectively.
【学位授予单位】：济南大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.37
本文编号：2150957
[Abstract]:Background & objective rectal cancer is one of the most common malignant digestive tract tumors in medical diagnosis and treatment worldwide. In recent years, doctors have tended to choose (total mesorectal excision), also known as TME surgery, for rectal cancer under conditions permitting-this procedure can effectively reduce the local recurrence rate of rectal cancer by removing complete mesorectum. But when the circumferential margin (circumferential resection is positive, that is, the cancer infiltrates or penetrates the proper fascia of the rectum, the TME principle also loses its value. Therefore, it is an important index to evaluate the effect of total mesorectal resection by means of continuous section (coronal plane) of magnetic resonance (MRI) to observe the tumor invasion at the margin of mesentery and complete rectal cancer. Neoadjuvant chemotherapy is beneficial to complete resection of rectal tumors, increase the chance of anal preservation and reduce the risk of local recurrence. About 20% of the patients can obtain complete pathological remission of (pathologic complete responsep CR (12 / 2). At present, the development direction of tumor therapy is individualized treatment. It is very important to select the patients who need neoadjuvant radiotherapy and chemotherapy and those who can be operated directly. It is very important to use (High Resolution MRI HR-MRI (high resolution magnetic resonance imaging) to clearly display the level of rectal wall in order to stage rectal cancer patients accurately, because this determines the individual treatment strategy of patients with rectal cancer. The purpose of this study was to analyze and evaluate the value of high resolution MRI in the evaluation of peri-circumferential margin and preoperative staging of rectal neoplasms. Methods Forty patients with primary rectal cancer were analyzed prospectively, with an average age of 52.3 years and a range of 32 to 74 years. All the patients were diagnosed as rectal adenocarcinoma by endoscopy, and all of them signed the relevant informed consent. High resolution magnetic resonance imaging was performed before operation. Two radiologists were asked to read the films and analyze and evaluate the MRI-T staging status and mesenteric fascia status of all patients. After comparing the results with the pathological results of the patients after surgery, the accuracy and sensitivity of the related predictors were calculated, respectively. Specificity, positive predictive value (Positive Predictive) and negative predictive value (negative predictive value). The preoperative and postoperative staging criteria for rectal cancer were derived from the 7th edition of the AJCC Cancer staging Manual. Results 1) 25 patients were located in the upper rectum (62.5%), 7 patients were located in the middle rectum (17.5%), 8 patients were located in the distal rectum (20.0%) the predictive value of sensitive (sensitivity), specific (specificity), positive value based on MRI for preoperative T staging was (PPV) and negative. The predictive value of sex (NPV) was 95.2% and 93.3% respectively (Kappa 0.84%), the predictive value of (sensitivity), specific (specificity), positive predictive value of circumferential margin (CRM) based on MRI and negative predictive value of (PPV) were 96.7% and 96.7% (Kappa 0.61P0.05) respectively, and the accuracy of (accuracy), sensitive (sensitivity), (specificity), positive predictive value of MRI-N staging was 96.7% and 96.7% respectively (Kappa 0.61P0.05), and the predictive value of (sensitivity), specific (specificity), positive predictive value and negative predictive value of circumferential (CRM) based on MRI were 96.7% and 96.7% (Kappa 0.61P0.05) respectively. The values of (PPV) and (NPV) were 84.6% and 96.7% respectively (P 0.05). Conclusion High resolution MRI can be used to evaluate the mesenteric fascia and circumferential margin of rectal cancer effectively.
【学位授予单位】：济南大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.37
【参考文献】
相关期刊论文 前1条
1 万德森;;我国结直肠癌的流行趋势及对策[J];中华肿瘤杂志;2011年07期
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