Kluza Ewelina, Kleijnen Jean-Paul J E, Martens Milou H, Rennspiess Dorit, Maas Monique, Jeukens Cécile R L P N, Riedl Robert G, zur Hausen Axel, Beets Geerard L, Beets-Tan Regina G H
Department of Radiology, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, 6202 AZ, Maastricht, Netherlands.
Department of Surgery, GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, Netherlands.
Eur Radiol. 2016 May;26(5):1311-9. doi: 10.1007/s00330-015-3955-1. Epub 2015 Aug 30.
To evaluate the MRI macroscopic and microscopic parameters of mesorectal vasculature in rectal cancer patients.
Thirteen patients with rectal adenocarcinoma underwent a dynamic contrast-enhanced MRI at 1.5 T using a blood pool agent at the primary staging. Mesorectal macrovascular features, i.e., the number of vascular branches, average diameter and length, were assessed from baseline-subtracted post-contrast images by two independent readers. Mesorectal microvascular function was investigated by means of area under the enhancement-time curve (AUC). Histopathology served as reference standard of the tumour response to CRT.
The average vessel branching in the mesorectum around the tumour and normal rectal wall was 8.2 ± 3.8 and 1.7 ± 1.3, respectively (reader1: p = 0.001, reader2: p = 0.002). Similarly, the tumour-surrounding mesorectum displayed circa tenfold elevated AUC (p = 0.01). Interestingly, patients with primary node involvement had a twofold higher number of macrovascular branches compared to those with healthy nodes (reader1: p = 0.005 and reader2: p = 0.03). A similar difference was observed between good and poor responders to CRT, whose tumour-surrounding mesorectum displayed 10.7 ± 3.4 and 5.6 ± 1.5 vessels, respectively (reader1/reader2: p = 0.02).
We showed at baseline MRI of rectal tumours a significantly enhanced macrovascular structure and microvascular function in rectal tumour-surrounding mesorectum, and the association of primary mesorectal macrovascular parameters with node involvement and therapy response.
• Vascular MRI reveals macrovascular and microvascular abnormalities in the rectal tumour-surrounding mesorectum. • Formation of highly vascular stroma precedes the actual tumour invasion. • High macrovascular parameters are associated with node involvement. • Mesorectal vascular network differs for good and poor responders.
评估直肠癌患者直肠系膜血管的MRI宏观和微观参数。
13例直肠腺癌患者在初次分期时接受了1.5T动态对比增强MRI检查，使用血池造影剂。由两名独立阅片者从对比剂注射后减去基线的图像中评估直肠系膜大血管特征，即血管分支数量、平均直径和长度。通过增强时间曲线下面积（AUC）研究直肠系膜微血管功能。组织病理学作为肿瘤对CRT反应的参考标准。
肿瘤周围直肠系膜和正常直肠壁的平均血管分支数分别为8.2±3.8和1.7±1.3（阅片者1：p=0.001，阅片者2：p=0.002）。同样，肿瘤周围直肠系膜的AUC升高约10倍（p=0.01）。有趣的是，有原发淋巴结受累的患者与无淋巴结受累的患者相比，大血管分支数量增加了两倍（阅片者1：p=0.005，阅片者2：p=0.03）。在CRT治疗反应良好和反应不佳的患者之间也观察到类似差异，其肿瘤周围直肠系膜的血管分别为10.7±3.4和5.6±1.5（阅片者1/阅片者2：p=0.02）。
我们在直肠肿瘤的基线MRI检查中发现，肿瘤周围直肠系膜的大血管结构和微血管功能显著增强，以及直肠系膜大血管参数与淋巴结受累和治疗反应之间的关联。
•血管MRI显示肿瘤周围直肠系膜存在大血管和微血管异常。•高度血管化间质的形成先于肿瘤实际侵袭。•高的大血管参数与淋巴结受累相关。•直肠系膜血管网络在治疗反应良好和不佳的患者中有所不同。
