本文選題：磁共振成像 + 術(shù)前放化療�。� 參考：《浙江大學(xué)》2015年碩士論文

【摘要】：目的 分析并評(píng)價(jià)磁共振成像(MRI)對(duì)局部進(jìn)展期直腸癌新輔助放化療(N-CRT)后再分期的準(zhǔn)確性。 資料及方法 回顧性分析了94例經(jīng)病理確診的局部進(jìn)展期中低位直腸非粘液性腺癌患者的臨床資料,所有患者均接受了N-CRT,并且在治療結(jié)束6-8周后進(jìn)行了根治性手術(shù),新輔助治療前后MRI影像資料均由一位放射科專家進(jìn)行閱片,并與相應(yīng)的術(shù)后病理結(jié)果進(jìn)行比較。計(jì)算MRI對(duì)T再分期及N再分期的準(zhǔn)確率。用Kappa統(tǒng)計(jì)學(xué)分析方法檢驗(yàn)N-CRT后MRI分期與術(shù)后病理分期的一致性。 結(jié)果 N-CRT后MRd對(duì)腫瘤T分期的診斷準(zhǔn)確率為49%,分別有40.4%T分期過高和10.6%T分期過低。達(dá)到病理完全緩解(pCR)的患者,只有18%在術(shù)前MRI上得到準(zhǔn)確的預(yù)測(cè),但是我們發(fā)現(xiàn)MRI預(yù)測(cè)pCR的特異性值為100%。N-CRT后MRI對(duì)N分期診斷準(zhǔn)確率為63.8%,其中有26.6%N分期過高,9.6%N分期過低。Kappa分析結(jié)果顯示,N-CRT后MRI分期與術(shù)后病理分期的一致性較差,T分期：K=0.156,N分期：K=0.289。 結(jié)論 直腸癌N-CRT后MRI分期的診斷準(zhǔn)確率較低,如何提高術(shù)前分期的診斷水平仍是一個(gè)挑戰(zhàn),臨床迫切需要一種更準(zhǔn)確的技術(shù)方法。鑒于MRI判斷pCR的特異性非常高,在遵循目前治療規(guī)范的前提下,對(duì)于那些達(dá)到pCR但又不能耐受或是拒絕手術(shù)的患者,可考慮選擇密切臨床隨訪。
[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.
【學(xué)位授予單位】：浙江大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2015
【分類號(hào)】：R735.37

【參考文獻(xiàn)】

相關(guān)期刊論文 前1條

1 鄧海軍;李國(guó)新;齊德林;;直腸癌的術(shù)前影象學(xué)分期[J];世界華人消化雜志;2000年07期

，

本文編號(hào)：1893909