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目的:采用高分辨率小FOV双重造影结合DWI扫描技术,探讨磁共振成像(MRI)对直肠癌术前分期的意义。方法:收集2013年1月至2016年1月直肠癌的病例250例,综合所有序列对直肠癌病灶进行术前MRI-TN分期,评估直肠系膜筋膜和环周切缘是否累及,并与手术病理结果进行对照分析。结果:MRI T分期准确率为88.8%(222/250),MRI诊断直肠癌各T分期的准确率、敏感性、特异性、阳性预测值及阴性预测值与术后病理T分期的一致性较好,Kappa值=0.712,P=0.000。N分期准确率为75.6%(189/250),MRI诊断各N分期的准确率、敏感性、特异性、阳性预测值及阴性预测值,与术后病理的一致性为中度一致,Kappa值=0.623,P=0.000。环周切缘准确率为97.6%(58/52)。敏感性100%、特异性97.0%、阳性预测值及阴性预测值分别为89.7%、100%。结论:1薄层、小FOV高分辨率MRI双重造影结合DWI可以多参数、多角度对直肠癌术前T分期做出准确的分期,对N分期做出较准确分期。2 MRI可以对环周切缘有无累及进行准确的预测。3矢状位能准确测量肿瘤下缘距肛缘的距离,为术前评估是否保肛提供直观信息。
Objective: To investigate the significance of magnetic resonance imaging (MRI) in the preoperative staging of rectal cancer using high-resolution small FOV double contrast combined with DWI scanning. Methods: A total of 250 cases of rectal cancer from January 2013 to January 2016 were collected. Preoperative MRI-TN staging was performed on all the patients with rectal cancer. All the patients were enrolled in this study. Pathological results were analyzed. Results: The accuracy of MRI T stage was 88.8% (222/250). The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of MRI in diagnosing T stage of rectal cancer were more consistent with postoperative pathological T staging Good, Kappa value = 0.712, P = 0.000. The accuracy of N staging was 75.6% (189/250). The diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of N staging were consistent with postoperative pathology. The Kappa value = 0.623, P = 0.000. The accuracy of circumferential margin was 97.6% (58/52). Sensitivity 100%, specificity 97.0%, positive predictive value and negative predictive value were 89.7%, 100%. Conclusions: 1 Thin, small FOV high resolution MRI double contrast combined with DWI can make accurate staging of preoperative T staging of rectal cancer with multi-parameter and multi-angle, and make a more accurate staging of N staging. 2 MRI can accurately predict the presence or absence of a circumferential margin. 3 sagittal can accurately measure the distance from the anal margin of the lower edge of the tumor to provide visual information for preoperative assessment of anal sphincter preserving.