Koh D M, Brown G, Temple L, Blake H, Raja A, Toomey P, Bett N, Farhat S, Norman A R, Daniels I, Husband J E
Academic Department of Radiology, Cancer Research UK Magnetic Resonance Group, Institute of Cancer Research, Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK.
Eur Radiol. 2005 Aug;15(8):1650-7. doi: 10.1007/s00330-005-2751-8. Epub 2005 May 3.
The aim of this work was to determine the distribution of mesorectal lymph nodes using T2-weighted magnetic resonance (MR) imaging compared with histopathological findings in patients with rectal carcinoma. Sixteen patients with rectal carcinoma undergoing primary surgery without pre-operative neoadjuvant treatment were evaluated using 3-mm axial T2-weighted MR imaging. The position of each visible mesorectal node on imaging was localised by measuring its minimum distance from the mesorectal fascia (d(m)), its minimum distance from the rectal wall (d(r)) and its distance from the distal tumour margin (d(v)). Independent assessment of d(m), d(r) and d(v) was made at histopathological examination. Eighty-five mesorectal nodes on in vivo MR imaging were matched to histopathological findings. On imaging, 67/85 mesorectal nodes were found at the level of the tumour and 84/85 were identified at or within 5 cm proximal to the tumour. Only one out of 85 nodes was seen below the inferior tumour margin. The mean difference of d(m) and d(r) obtained on in vivo MR imaging and histopathological examination was 0.7 mm (95% confidence interval, CI, -0.12 to 1.42 mm) and -1.1 mm (95% CI -2.29 to 0.14 mm), respectively. Almost all mesorectal nodes visible on MR imaging were found at the level of tumour or within 5 cm proximal to the tumour. This has implications for the planning of MR imaging and the level of mesorectal transection at surgery.
本研究旨在通过T2加权磁共振（MR）成像确定直肠癌患者中直肠系膜淋巴结的分布，并与组织病理学结果进行比较。对16例未经术前新辅助治疗而接受初次手术的直肠癌患者进行3毫米层厚的轴向T2加权MR成像评估。通过测量每个可见的直肠系膜淋巴结与直肠系膜筋膜的最小距离（d(m)）、与直肠壁的最小距离（d(r)）及其与肿瘤远端边缘的距离（d(v)）来确定其在图像上的位置。在组织病理学检查时对d(m)、d(r)和d(v)进行独立评估。将85个活体MR成像上的直肠系膜淋巴结与组织病理学结果进行匹配。在成像中，85个直肠系膜淋巴结中有67个位于肿瘤水平，84个位于肿瘤近端5厘米或以内。85个淋巴结中只有1个位于肿瘤下缘以下。活体MR成像与组织病理学检查获得的d(m)和d(r)的平均差异分别为0.7毫米（95%置信区间，CI，-0.12至1.42毫米）和-1.1毫米（95%CI -2.29至0.14毫米）。几乎所有在MR成像上可见的直肠系膜淋巴结都位于肿瘤水平或肿瘤近端5厘米以内。这对MR成像的规划和手术中直肠系膜横断的水平具有重要意义。
