Koh Dow-Mu, Smith Neil J, Swift R Ian, Brown Gina
Academic Department of Radiology, Royal Marsden Hospital, U.K.
Clin Med Oncol. 2008;2:267-73. doi: 10.4137/cmo.s370. Epub 2008 Apr 1.
To investigate the relationship between extramural venous invasion (EMVI) detected at T2-weighted MRI and nodal disease rectal cancer compared with histopathology.
The MR imaging of 79 consecutive patients with rectal cancer who underwent primary rectal surgery without neoadjuvant treatment were reviewed. MR images were scored by an expert radiologist for the presence and degree of EMVI using a five point scale blinded to pathological findings. Receiver operating characteristic curve analyses were performed to determine the sensitivity and specificity of MRI scoring in predicting EMVI and nodal disease at histopathology.
Compared with histology, an MR score of >2 was found to have 100% sensitivity (95% CI: 77%-100%) and 89% specificity (95% CI: 79%-96%) in identifying EMVI involving veins >3 mm in diameter. An EMVI score of >2 was had a sensitivity of 56% (95% CI: 30%-80%) and specificity of 81% (95% CI: 69%-90%) for identifying patients with stage N2 disease.
EMVI score of >2 on T2-weighted MR imaging has a high sensitivity and specificity for histopathologically proven extramural venous invasion involving venules ≥3 mm in diameter. However, EMVI scores have only moderate sensitivity in the predicting nodal involvement.
探讨T2加权磁共振成像（MRI）检测到的壁外静脉侵犯（EMVI）与直肠癌淋巴结疾病之间的关系，并与组织病理学结果进行比较。
回顾性分析79例未经新辅助治疗直接接受直肠手术的直肠癌患者的MR成像资料。由一名专业放射科医生对MR图像进行评分，采用五分制评估EMVI的存在及程度，评分时对病理结果保密。进行受试者操作特征曲线分析，以确定MRI评分在预测组织病理学上的EMVI和淋巴结疾病方面的敏感性和特异性。
与组织学结果相比，发现MR评分>2在识别直径>3mm静脉的EMVI时具有100%的敏感性（95%CI：77%-100%）和89%的特异性（95%CI：79%-96%）。EMVI评分>2在识别N2期疾病患者时，敏感性为56%（95%CI：30%-80%），特异性为81%（95%CI：69%-90%）。
T2加权MR成像上EMVI评分>2对组织病理学证实的直径≥3mm小静脉的壁外静脉侵犯具有较高的敏感性和特异性。然而，EMVI评分在预测淋巴结受累方面仅具有中等敏感性。
