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目的:分析和研究MRI减影技术结合DWI在直肠癌术前TN分期的临床应用价值。方法:收集2010年8月~2013年12月期间经我院外科手术及病理证实的原发直肠癌患者53例。MRI序列包括常规TSE-T1WI、-T2WI、弥散成像(DWI)及反转恢复频率饱和成像(SPIR)序列。全部患者均行多方位增强扫描,而且保证有一个方位必须垂直肿块所在平面的肠管长轴,将增强扫描前后同方位图像进行减影处理,由两名高年资专家读片,并作术前TN分期。病理参考标准以Dukes分期为标准,并用Kappa方法检验MRI减影技术在直肠癌术前分期与病理结果一致性差异,统计学处理采用SPASS 19.0。结果:53例直肠癌患者中,MRI减影技术结合DWI对直肠癌检出率为100%,正确T分期49例,过低分期1例,过高分期3例,准确率为92.5%(49/53),与病理结果一致性较好。按照MRI术前提示,手术切除淋巴结283枚,53例患者术后病检伴有淋巴结转移者36例,转移性淋巴结184枚,DWI结合常规序列术前评价淋巴结转移可靠性大。结论:MRI减影技术结合DWI方便、快捷,对直肠癌的诊断及术前TN分期准确性高,值得推广应用。
Objective: To analyze and study the value of MRI subtraction and DWI in preoperative TN staging of rectal cancer. Methods: 53 cases of primary rectal cancer confirmed by surgery and pathology in our hospital from August 2010 to December 2013 were collected. MRI sequences include conventional TSE-T1WI, -T2WI, diffusion imaging (DWI), and reverse recovery frequency saturation imaging (SPIR) sequences. All patients underwent multi-directional enhanced scan, but also to ensure that there must be an orientation perpendicular to the plane where the long axis of the intestine will be enhanced before and after scanning the same azimuth image subtraction processing, read by two high-tech experts, and preoperative TN staging. The pathological reference standard was Dukes staging, and Kappa method was used to test the consistency of MRI subtraction technique in preoperative rectal cancer staging and pathological results. Statistical analysis adopted SPASS 19.0. Results: Among the 53 rectal cancer patients, the detection rate of rectal cancer by MRI subtraction and DWI was 100%. There were 49 cases with correct T stage, 1 case with too low staging, 3 cases with too much staging, and the accuracy rate was 92.5% (49 / 53), consistent with the pathological results better. According to the preoperative MRI tips, there were 283 cases of lymph node resection. Among the 53 cases, 36 cases with lymph node metastasis and 184 cases with metastatic lymph node disease were examined by postoperative pathology. DWI combined with routine preoperative evaluation of lymph node metastasis was reliable. Conclusion: MRI subtraction and DWI combined with DWI are convenient and rapid, and the diagnosis of rectal cancer and the accuracy of preoperative TN staging are worthy of popularization and application.