Fukunaga Hiroki, Sekimoto Mitsugu, Tatsumi Mitsuaki, Ikenaga Masakazu, Ohue Masayuki, Seshimo Iwao, Higuchi Ichiro, Takayama Osamu, Yasui Masayoshi, Ikeda Masataka, Yamamoto Hirofumi, Monden Morito
Department of Surgery and Clinical Oncology, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.
Int J Oncol. 2002 Apr;20(4):691-5.
Local recurrence of rectal cancer is a critical issue. Anatomical images, such as computed tomography (CT) or magnetic resonance imaging (MRI), are sometimes insufficient for preoperative evaluation. A useful modality for diagnosis of local recurrence of rectal cancer is (18)F-2-fluoro-2-deoxy-D-glucose positron emission tomography (FDG-PET), but it does not give adequate information about anatomy. To utilize the advantages of these techniques, this study was done to validate the accuracy of using fused images and their usefulness in the decision making for surgical intervention of local recurrence of rectal cancer by directly comparing the fused images with resected specimens. PET and CT/MRI were performed for patients suspected of local recurrence of rectal cancer (n=4). PET image data were re-calculated to fit CT/MRI images and manually superimposed on the anatomical images. Fusion images were compared with resected specimens. Radical operation was carried out for three patients. Fusion images provided information on precise tumor location, and extent of tumor invasion as well as the diagnosis of tumor recurrence. All patients underwent curative operation with negative surgical margins, and the information provided by the fusion images was confirmed by comparison with resected specimens. In all cases, preoperative evaluation of tumor recurrence with fusion images provided more useful clinical information for the management of patients than the anatomical images alone. PET images, when combined with MRI or CT, may prove to be a useful adjunct in the management of patients being evaluated for resection of local recurrence of rectal cancer.
直肠癌的局部复发是一个关键问题。解剖学影像，如计算机断层扫描（CT）或磁共振成像（MRI），有时在术前评估中并不充分。用于诊断直肠癌局部复发的一种有用方法是（18）F - 2 - 氟 - 2 - 脱氧 - D - 葡萄糖正电子发射断层扫描（FDG - PET），但它无法提供足够的解剖学信息。为了利用这些技术的优势，本研究通过将融合图像与切除标本直接比较，来验证使用融合图像的准确性及其在直肠癌局部复发手术干预决策中的有用性。对疑似直肠癌局部复发的患者（n = 4）进行了PET和CT/MRI检查。重新计算PET图像数据以使其与CT/MRI图像匹配，并手动叠加在解剖学图像上。将融合图像与切除标本进行比较。对三名患者进行了根治性手术。融合图像提供了有关肿瘤精确位置、肿瘤浸润范围以及肿瘤复发诊断的信息。所有患者均接受了手术切缘阴性的根治性手术，并且融合图像提供的信息通过与切除标本比较得到了证实。在所有病例中，与单独的解剖学图像相比，术前用融合图像评估肿瘤复发为患者的管理提供了更有用的临床信息。PET图像与MRI或CT结合时，可能被证明是评估直肠癌局部复发切除术患者管理中的一种有用辅助手段。
