【摘要】：目的 1、評估空氣對比劑灌腸MR結(jié)腸成像的可行性和成像質(zhì)量； 2、評估MR結(jié)腸成像對結(jié)直腸腫塊檢出的敏感性； 3、對結(jié)直腸癌進(jìn)行術(shù)前分期。 材料和方法 搜集我院2012年7月～2014年3月因?yàn)榧S便隱血實(shí)驗(yàn)陽性、排便性狀改變、腹部包塊等疑似結(jié)直腸癌患者30例(其中男19例,女11例,年齡21-78歲,中位年齡52歲)。所有患者均沒有MR檢查的禁忌癥,并且都經(jīng)纖維結(jié)腸鏡和病理證實(shí)。 患者均在檢查前一天進(jìn)流質(zhì)飲食并進(jìn)行腸道準(zhǔn)備,檢查前10min肌肉注射丁溴東莨菪堿(解痙靈)20mmg,經(jīng)直腸導(dǎo)管注入空氣1000-1300ml后開始掃描。采用SSFSE和FIESTA序列在一次屏氣時冠狀位掃描全部結(jié)直腸圖像,對疑似病變部位進(jìn)行T1WI、T2WI和DWI序列橫軸位掃描,直腸病變時加掃矢狀位。觀察患者的耐受性,分析腸道準(zhǔn)備質(zhì)量和MR結(jié)直腸圖像質(zhì)量。在纖維結(jié)腸鏡和手術(shù)病理對照下,計(jì)算結(jié)直腸腫塊檢出的敏感性和結(jié)直腸癌術(shù)前分期的準(zhǔn)確性。 結(jié)果 1、MR結(jié)腸成像的可行性與成像質(zhì)量 使用空氣作為對比劑灌腸安全并且沒有成本,所有患者均完成MR結(jié)腸成像檢查,在檢查期間僅有腹脹感,但在檢查結(jié)束后的24小時內(nèi)沒有不適感和其他并發(fā)癥。共得到240個腸段圖像,準(zhǔn)備良好的腸段為80.83%(194/240),1級擴(kuò)張腸段為77.08%(185/240)。升結(jié)腸、結(jié)腸肝曲、橫結(jié)腸和結(jié)腸脾曲擴(kuò)張程度優(yōu)于盲腸、降結(jié)腸、乙狀結(jié)腸和直腸,經(jīng)卡方檢驗(yàn)二者差異有顯著性(χ2=5.03,P0.05)。圖像中腸段偽影最少的是盲腸和直腸各1段(3.33%),最多的則集中在結(jié)腸肝曲和橫結(jié)腸各4段(13.33%)。 2、結(jié)直腸腫塊檢查敏感性 與纖維結(jié)腸鏡和病理結(jié)果對照比較,空氣灌腸MR結(jié)腸成像對腫塊檢出的敏感性為：大于10mm腫塊檢出敏感度為91.42%(32/35),5～10mm腫塊檢出敏感度66.67%(6/9),小于5mm的病變僅檢出1個(1/3)。 3、結(jié)直腸癌術(shù)前分期 25個結(jié)直腸癌病灶均定位定性準(zhǔn)確,MR結(jié)腸成像TNM分期準(zhǔn)確性為76.67%(23/30)。T分期總的準(zhǔn)確率為83.33%(25/30),其中：≤T2期分期準(zhǔn)確性為80%(8/10),T3期分期準(zhǔn)確性為83.33%(15/18),T4期分期準(zhǔn)確性為100%(2/2)。腫瘤漿膜外侵犯的敏感度為85%(17/20),特異度為80%(8/10)。N分期總的準(zhǔn)確性為76.67%(23/30),其中：NO期分期準(zhǔn)確性為78.58%(11/14),N1期分期準(zhǔn)確性為75%(9/12),N2期分期準(zhǔn)確性為75%(3/4)。淋巴結(jié)轉(zhuǎn)移的敏感度為81.25%(13/16),特異度為78.58%(11/14)。M分期總檢出率為80%(4/5),MR結(jié)腸成像發(fā)現(xiàn)了肝臟轉(zhuǎn)移灶4例,但1例后腹膜轉(zhuǎn)移未檢出。 結(jié)論 ①空氣是一種安全、無成本的對比劑,患者接受度高,基本無不良反應(yīng)。 ②空氣對比劑灌腸MR結(jié)腸成像腸道擴(kuò)張程度好,軟組織分辨率高并且沒有電離輻射,對結(jié)直腸腫塊的檢測是一種有吸引力和潛力的影像學(xué)方法。 ③空氣對比劑灌腸MR結(jié)腸成像對結(jié)直腸癌術(shù)前分期準(zhǔn)確,能評估腫瘤漿膜外侵犯、淋巴結(jié)和遠(yuǎn)端器官的轉(zhuǎn)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，

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