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MRI对直肠癌环周切缘状态评估的价值

白玫1,刘弘毅2,韩悦1,李亮1   

  1. 1. 天津医科大学第二医院
    2. 天津医科大学
  • 收稿日期:2012-04-24 修回日期:2012-09-12 出版日期:2013-01-15 发布日期:2013-01-15
  • 通讯作者: 白玫

Evaluation of MRI in the Circumferential Resection Margin of Rectal Cancer

  • Received:2012-04-24 Revised:2012-09-12 Published:2013-01-15 Online:2013-01-15
  • Contact: Mei BAI

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摘要：

【摘要】 目的探讨MRI对直肠癌环周切缘(CRM)有无癌浸润评估的可靠性。方法对7例尸体盆腔局部标本(标本组)、10例健康志愿者(对照组)、49例直肠癌患者(患者组)行盆腔MRI检查。检查后将标本组行局部解剖及组织切片,患者组行直肠全系膜切除术(TME)及术后病理检查。将标本组和对照组的MRI、组织切片进行对照,并测量患者组MRI片上肿瘤、转移淋巴结及癌结节的外缘与直肠系膜筋膜的最短距离,当此距离≤5mm记为CRM(+),>5mm为CRM(-),与病理结果对照。结果标本组直肠系膜筋膜解剖上为一层状筋膜,显微镜下为一条状结缔组织,标本组及对照组MRI片上直肠系膜筋膜在T1WI、T2WI上呈一线状低信号影,其内可见正常淋巴结、小血管、淋巴管及血管神经束影,MRI表现与解剖之间具有一致性。患者组49例术前MRI判断直肠癌CRM阳性22例、阴性27例,与术后病理结果对照MRI总体判断准确率为91.8%(45/49);误判4例,2例假阳性,病理为炎性增生反应;2例假阴性,病理可见微转移灶浸润。结论 MRI是目前对直肠癌术前CRM状态评估较可靠的影像学检查方法。

关键词: 直肠肿瘤, 筋膜, 直肠, 磁共振成像, 环周切缘

Abstract: Objective: To explore the reliability of MRI in the assessment of whether rectal cancer patients have invasive carcinoma on circumferential resection margin (CRM). Methods: Examine 7 corpses partial sectional specimens (specimen group), 10 healthy volunteers (compare group) and 49 rectal cancer patients (patient group) using MRI. Then dissect the corpse specimen and perform total mesorectal excision to the patient group. Compare the MRI result of the compare group and the specimen group, and measure the distance between mesorectal soft tissue nodules, irregular streaks shadow and mesorectal fascia of patient group MRI result. It is CRM (+) when this distance > 5mm, and it is CRM (-) if the distance < 5mm, compared with pathological findings. Result: The mesorectum fascia of both specimen group and patient group is shown on both T1WI and T2WI as a low-signal-intensity linear structure, lymph node, blood vessels, and lymphatic vessels are all shown. The MRI result is consistent with the anatomy result. Preoperative pathology results in patient group showed 22 positive CRMs, 27 negative CRMs. CRM judgment by MRI was consistent with the pathology results in 45(91.8％) of 49 patients．4 cases were misjudged: 2 patients with false positive results and 2 patients with false negative result. Conclusion: MRI is a relatively reliable method in evaluating the status of CRM.

Key words: Rectal cancer, Fascia, Rectum, MRI, Circumferential reseetion margin