Pegios W, Hünerbein M, Schröder R, Wust P, Schlag P, Felix R, Vogl T J
Institut für Diagnostische und Interventionelle Radiologie, Berlin, Germany.
Rofo. 2002 Jun;174(6):731-7. doi: 10.1055/s-2002-32218.
This study was designed to evaluate the accuracy and limitations for staging of contrast-enhanced endorectal MR imaging comparing with transrectal US for restaging of rectal lesions after surgery or after therapeutic radiation. Both methods were correlated with histologic findings.
METHOD/MATERIALS: The efficacy of these both methods was evaluated in 30 patients with supposed residual or recurrent rectal neoplasms. Contrast enhanced (bolus injection of 0.1 mmol/kg b.w. Gd-DTPA) endorectal MR imaging was performed using a 1.5 Tesla Magnetom. In addition endosonography (7.5 x or 10-MHz transducer) was used.
In 8 patients with rectal adenoma after electro-laser resection, 8 patients with rectal carcinoma stage pT1 after transanal resection, 8 patients with rectal carcinoma stage pT2 and 6 patients with rectal carcinoma stage pT3 after regional hyperthermia with radiochemo-therapy, the following results were obtained during the postsurgical or posttherapeutical follow-up with respect to histopathological evaluation: exact staging in 86.6 % with EMRI and 63.3 % in ES, overstaging in 8 % (EMRI) and 23 % (ES), understaging in 0 % (EMRI) and 7 % (ES). The highest diagnostic accuracy was shown in EMRT in patients with rectal adenoma and rectal carcinoma (pT1) and after electro-laser resection or transanal resection during follow-up.
Contrast enhanced endorectal MR imaging appears to be very promising for accurate posttherapeutical staging of rectal cancer and helpful in the diagnosis of recurrence or the differentiation between scar tissue and residual rectal tumor.
本研究旨在评估对比增强直肠内磁共振成像（EMRI）与经直肠超声（ES）对直肠病变术后或治疗性放疗后再分期的准确性及局限性。两种方法均与组织学结果相关。
方法/材料：对30例疑似直肠肿瘤残留或复发的患者评估这两种方法的有效性。使用1.5特斯拉Magnetom磁共振仪进行对比增强（静脉注射0.1 mmol/kg体重的钆喷酸葡胺）直肠内磁共振成像。此外，使用了超声内镜检查（7.5×或10兆赫探头）。
在8例接受电激光切除术后的直肠腺瘤患者、8例经肛门切除术后pT1期直肠癌患者、8例接受放化疗区域热疗后pT2期直肠癌患者和6例pT3期直肠癌患者中，在术后或治疗后随访期间进行组织病理学评估得到以下结果：EMRI准确分期率为86.6%，ES为63.3%；EMRI过度分期率为8%，ES为23%；EMRI无低估分期情况，ES低估分期率为7%。EMRT在直肠腺瘤和直肠癌（pT1）患者以及随访期间接受电激光切除或经肛门切除术后的患者中显示出最高的诊断准确性。
对比增强直肠内磁共振成像对于直肠癌治疗后的准确分期似乎非常有前景，有助于诊断复发或区分瘢痕组织与残留直肠肿瘤。
