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目的评估磁共振成像(MRI)预测直肠癌分期和侧切缘受累的准确程度。方法术前活检病理证实的直肠癌53例,用高分辨率MRI评估肿瘤(T)、系膜淋巴结转移(N)和侧切缘(CRM),所有病例均行全直肠系膜切除术,采用连续病理切片法观察手术标本,对照术前MRI和术后病理结果,评估MRI能否准确预测直肠癌T、N、CRM。结果MRI正确T分期41例,错误12例,其中4例T1~T2期报告为T3期,8例T3期报告为T1~T2期,T分期的总准确率为77·4%(41/53),其中T1~T2期的预测准确率为83·3%(20/24),T3期的准确率为68·0%(17/25),T4期的准确率为100%(4/4),MRI可以对T分期进行一般预测,但准确度不高(Kappa值为0·602,P<0·001)。MRI对直肠系膜淋巴结正确分期37例,错误分期16例,其中高估10例,低估6例,准确率为69·8%(37/53),灵敏度为75%(18/24),特异度为65·5%(19/29),MRI不能对系膜淋巴结做出准确预测(Kappa值为0·399,P=0·003)。MRI正确预测CRM51例,错误2例,其中高估1例,低估1例,准确率为96·2%(51/53),灵敏度为80%(1/5),特异度为97·9%(47/48)。MRI可以准确预测CRM是否受累(Kappa值为0·779,P<0·001)。结论术前MRI不能准确预测直肠癌T、N分期,但可以可靠地预测CRM是否受累。
Objective To evaluate the accuracy of magnetic resonance imaging (MRI) in predicting the staging and lateral margin involvement of rectal cancer. Methods 53 patients with rectal cancer confirmed by biopsy before operation were recruited. Tumor (T), mesorectal lymph node metastasis (N) and lateral margin (CRM) were evaluated by high-resolution MRI. All cases underwent total mesorectal excision and continuous pathology was used. Surgical specimens were observed by sectioning method. Preoperative MRI and postoperative pathological results were compared to evaluate whether MRI can accurately predict rectal cancer T, N, and CRM. RESULTS: There were 41 cases of correct T-stage MRI and 12 cases of errors. Among them, 4 cases were reported as T3 in T1~T2, 8 cases were reported as T1~T2 in T3, and the total accuracy of T stage was 77.4% (41/53). ), Of which T1 ~ T2 period of the prediction accuracy rate of 83. 3% (20/24), T3 period accuracy rate of 68.0% (17/25), T4 period accuracy rate of 100% (4/4 MRI can be used to make general predictions of T staging, but the accuracy is not high (Kappa value is 0·602, P<0.001). MRI correctly staged mesorectal lymph nodes in 37 cases and mis-staged in 16 cases, including overestimation of 10 cases, underestimation of 6 cases, accuracy rate of 69.8% (37/53), sensitivity of 75% (18/24), specificity At 65.5% (19/29), MRI did not accurately predict mesangial lymph nodes (Kappa value was 0.399, P=0.003). MRI correctly predicted 51 cases of CRM and 2 cases of errors, including overestimation in 1 case, underestimation in 1 case, accuracy rate of 96. 2% (51/53), sensitivity of 80% (1/5), and specificity of 97.9% (47/48). MRI can accurately predict whether CRM is affected (Kappa value is 0·779, P<0·001). Conclusion Preoperative MRI cannot accurately predict T and N staging of rectal cancer, but it can reliably predict whether CRM is affected.