复发性或残留盆腔肠癌：挽救性手术前MRI对局部范围评估的准确性

Recurrent or residual pelvic bowel cancer: accuracy of MRI local extent before salvage surgery.

作者信息

Robinson Philip, Carrington Bernadette M, Swindell Ric, Shanks Johnathan H, O'dwyer Sarah T

机构信息

Departments of Diagnostic Radiology, Christie Hospital NHS Trust, Manchester, UK.

出版信息

Clin Radiol. 2002 Jun;57(6):514-22. doi: 10.1053/crad.2002.0933.

DOI:10.1053/crad.2002.0933

PMID:12069470

Abstract

PURPOSE

To determine pre-operative MRI accuracy in assessing local disease extent in recurrent/residual pelvic bowel cancer by comparing MRI assessment and staging examination under anaesthesia (EUA), with laparotomy/histopathological findings.

MATERIALS AND METHODS

Twenty-seven consecutive patients with recurrent (n = 21) or residual (n = 6) pelvic bowel cancer (13 of the rectum, eleven of the anus and three of the colon) underwent EUA and pelvic MRI (1T) using a phased array pelvic coil. Retrospective analysis of eight specific anatomical regions for tumour involvement on MRI was performed. Findings at EUA and biopsy were recorded. The MRI and EUA findings were correlated with findings at surgery and histopathology. Statistical comparison between MRI and EUA results was performed using the chi-squared test.

RESULTS

Overall MRI accuracy in determining tumour invasion for all sites assessed was 452/499 (91%), sensitivity was 95/109 (87%), specificity was 357/390 (92%), positive predictive value (PPV) was 95/128 (74%) and negative predictive value (NPV) was 357/371 (96%). PPV and NPV for specific areas were 21/38 (55%) and 134/136 (99%) for genitourinary tract, 4/6 (67%) and 61/65 (94%) for pelvic side wall, 21/26 (81%) and 40/41 (98%) for pelvic floor, 1/6 (17%) and 40/43 (93%) for the posterior pelvis pre-sacrum/sacrum. For those anatomical sites evaluated by both EUA and MRI, MRI was superior to EUA, with an accuracy of 89% vs 73% (P < 0.05).

CONCLUSION

MRI is an accurate technique for assessing disease extent in recurrent/residual pelvic bowel cancer.

摘要

目的

通过比较磁共振成像（MRI）评估与麻醉下分期检查（EUA）以及剖腹手术/组织病理学检查结果，确定术前MRI在评估复发性/残留性盆腔肠道癌局部疾病范围方面的准确性。

材料与方法

连续27例复发性（n = 21）或残留性（n = 6）盆腔肠道癌患者（直肠13例、肛门11例、结肠3例）接受了EUA和使用相控阵盆腔线圈的盆腔MRI（1T）检查。对MRI上肿瘤累及的八个特定解剖区域进行回顾性分析。记录EUA和活检结果。将MRI和EUA结果与手术和组织病理学结果进行关联。使用卡方检验对MRI和EUA结果进行统计学比较。

结果

在评估的所有部位中，MRI确定肿瘤侵犯的总体准确率为452/499（91%），敏感性为95/109（87%），特异性为357/390（92%），阳性预测值（PPV）为95/128（74%），阴性预测值（NPV）为357/371（96%）。特定区域的PPV和NPV分别为：泌尿生殖道21/38（55%）和134/136（99%），盆腔侧壁4/6（67%）和61/65（94%），盆底21/26（81%）和40/41（98%），骶骨前/骶骨后方盆腔1/6（17%）和40/43（93%）。对于同时接受EUA和MRI评估的那些解剖部位，MRI优于EUA，准确率分别为89%和73%（P < 0.05）。