直腸癌MRI與腸鏡對(duì)照及與病理的相關(guān)性研究
發(fā)布時(shí)間：2018-09-08 15:25
【摘要】：目的 1、應(yīng)用高分辨磁共振成像觀察直腸腸壁及其周圍解剖細(xì)節(jié)，總結(jié)其磁共振表現(xiàn)及信號(hào)特點(diǎn)；評(píng)價(jià)重要解剖結(jié)構(gòu)的顯示率，為部分解剖結(jié)構(gòu)提供影像學(xué)依據(jù)。 2、探討HR-MRI、DWI序列對(duì)直腸癌術(shù)前T、N分期的價(jià)值;探討直腸癌MRI、腸鏡分型與MVD的關(guān)系及ADC值與MVD的相關(guān)性。 材料和方法 應(yīng)用德國(guó)SIMENS公司1.5T Avanto型磁共振掃描儀，8通道線圈。收集80名正常人的盆腔多序列參數(shù)MR圖像，兩位高年資醫(yī)師共同閱片,統(tǒng)計(jì)其中60例圖像質(zhì)量較好,腸道偽影較少的直腸固有筋膜的前、后、左、右側(cè)的顯示率，以及Denonvillier，s筋膜、骶前筋膜、骶骨筋膜、腹膜返折、下腹下叢及直腸側(cè)韌帶的顯示率。觀察正常直腸壁各層結(jié)構(gòu)在不同磁共振序列上的信號(hào)特點(diǎn)。 兩位高年資醫(yī)師回顧性分析28例直腸癌患者M(jìn)R資料，以三組不同序列組合對(duì)病例進(jìn)行術(shù)前TN分期。第一組單獨(dú)使用常規(guī)序列，第二組常規(guī)序列結(jié)合HR-MRI，第三組常規(guī)序列結(jié)合HR-MRI和DWI，同時(shí)獲得ADC圖，避開(kāi)液化壞死區(qū)域，測(cè)得相應(yīng)的ADC值，三次測(cè)量后取平均值。各組術(shù)前MRI的分期分別與術(shù)后病理T、N分期比較，得出各組MR分期的正確率、靈敏度、特異度、陽(yáng)性預(yù)測(cè)值和陰性預(yù)測(cè)值、與病理分期一致性以及N分期約登指數(shù)。在MRI正中矢狀面圖像中取腫瘤與肛緣所切的最佳層面圖像，以腫瘤最下緣作為直腸癌病灶的下緣，沿直腸的曲度至肛緣做曲線并測(cè)量其長(zhǎng)度，與腸鏡測(cè)量結(jié)果比較。 所有病例術(shù)前行腸鏡檢查，觀察并記錄腸鏡表現(xiàn)。術(shù)后標(biāo)本切片進(jìn)行HE染色及CD34單克隆抗體SP法免疫組織化染色，計(jì)數(shù)400倍光鏡下5個(gè)視野內(nèi)微血管數(shù)，取平均值作為MVD值。統(tǒng)計(jì)MR分期、是否強(qiáng)化及腸鏡分型與MVD的關(guān)系及ADC值與MVD的相關(guān)性，ADC與MVD的相關(guān)性采用Spearman相關(guān)分析，不同分組病灶下緣距肛緣的距離及MVD值以均數(shù)±標(biāo)準(zhǔn)差（x±s）表示。采用t檢驗(yàn)，P＜0.05，差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果 1、高分辨磁共振可以清楚地顯示直腸壁的黏膜層、黏膜下層和固有肌層；直腸固有筋膜前、后、左、右側(cè)的顯示率分別為71.7%(43/60)，96.7%(58/60)，90.0%(54/60),93.3%(56/60)。Denonvillier，s筋膜、骶前筋膜、直腸骶骨筋膜、腹膜返折及下腹下叢的顯示率分別為68.3%（41/60）、65.0%（39/60）、86.6%（52/60）、86.3%（51/60）和90.0%（54/60），直腸側(cè)韌帶的顯示率較低，左側(cè)為53.3%（32/60），右側(cè)為46.7%（28/60）。 2、收集28例直腸癌患者M(jìn)R圖像，第一組T分期總的準(zhǔn)確率為71.4%（20/28），，Kappa=0.609，與病理術(shù)后結(jié)果的一致性一般。第二、三組T分期總的準(zhǔn)確率都為85.7%（24/28），Kappa=0.805，與病理術(shù)后結(jié)果的一致性較好。N分期中，第一組正確診斷的有20例，Kappa=0.440，登指數(shù)為0.542；第二組正確診斷的為21例，Kappa=0.505，約登指數(shù)為0.770；第三組正確診斷的為23例，Kappa=0.632約登指數(shù)為0.625。三組方法與術(shù)后病理結(jié)果N分期一致性均一般。 3、MRI測(cè)量病灶下緣距肛緣的距離與腸鏡測(cè)量結(jié)果比較，P0.05，差異無(wú)統(tǒng)計(jì)學(xué)意義。MR分期中T3-4期的MVD值為27.00±4.34較T1-2期20.47±3.60高，N1-2期為26.35±4.06較N0期19.09±2.98高，P0.05，差異有統(tǒng)計(jì)學(xué)意義。直腸癌MVD值在MRI增強(qiáng)掃描有、無(wú)強(qiáng)化及腸鏡不同分型之間進(jìn)行對(duì)照，P0.05,差異無(wú)統(tǒng)計(jì)學(xué)意義。ADC與MVD呈負(fù)相關(guān)(r=-0.743，P 0.05)。 結(jié)論 1、高分辨磁共振可以辨識(shí)直腸腸壁及周圍解剖細(xì)節(jié)，判斷鄰近組織是否受侵，為MRI術(shù)前分期提供理論基礎(chǔ)；為部分解剖結(jié)構(gòu)提供影像學(xué)依據(jù)。 2、HR-MRI和DWI在直腸癌T、N分期方面具有重要意義，MRI常規(guī)序列結(jié)合HR-MRI可以明顯提高直腸癌術(shù)前T分期的準(zhǔn)確性，與病理T分期比較具有較高的一致性。DWI雖不能提高T分期準(zhǔn)確性，但在N分期中可以提高可疑淋巴結(jié)的檢出率，約登指數(shù)以常規(guī)序列結(jié)合HR-MR序列最高。 3、磁共振可準(zhǔn)確的測(cè)量病灶下緣距肛門的距離。MR分期與ADC值對(duì)腫瘤中微血管密度具有術(shù)前提示作用，間接反映直腸癌的病程進(jìn)展，為臨床治療及判斷預(yù)后提供更多更有價(jià)值的參考指標(biāo)。
[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.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R735.37;R445.2
本文編號(hào)：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.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R735.37;R445.2
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