提高骨盆直肠癌分期的准确性：PET/MRI 的作用。

Improving staging of rectal cancer in the pelvis: the role of PET/MRI.

机构信息

Department of Radiology, Massachusetts General Hospital, Harvard Medical School, White Building Rm 250, 55 Fruit St, Boston, MA, 02114, USA.

Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA.

出版信息

Eur J Nucl Med Mol Imaging. 2021 Apr;48(4):1235-1245. doi: 10.1007/s00259-020-05036-x. Epub 2020 Oct 9.

DOI:10.1007/s00259-020-05036-x

PMID:33034673

Abstract

PURPOSE

The role of positron emission tomography/magnetic resonance (PET/MR) in evaluating the local extent of rectal cancer remains uncertain. This study aimed to investigate the possible role of PET/MR versus magnetic resonance (MR) in clinically staging rectal cancer.

METHODS

This retrospective two-center cohort study of 62 patients with untreated rectal cancer investigated the possible role of baseline staging PET/MR versus stand-alone MR in determination of clinical stage. Two readers reviewed T and N stage, mesorectal fascia involvement, tumor length, distance from the anal verge, sphincter involvement, and extramural vascular invasion (EMVI). Sigmoidoscopy, digital rectal examination, and follow-up imaging, along with surgery when available, served as the reference standard.

RESULTS

PET/MR outperformed MR in evaluating tumor size (42.5 ± 21.03 mm per the reference standard, 54 ± 20.45 mm by stand-alone MR, and 44 ± 20 mm by PET/MR, P = 0.004), and in identifying N status (correct by MR in 36/62 patients [58%] and by PET/MR in 49/62 cases [79%]; P = 0.02) and external sphincter infiltration (correct by MR in 6/10 and by PET/MR in 9/10; P = 0.003). No statistically significant differences were observed in relation to any other features.

CONCLUSION

PET/MR provides a more precise assessment of the local extent of rectal cancers in evaluating cancer length, N status, and external sphincter involvement. PET/MR offers the opportunity to improve clinical decision-making, especially when evaluating low rectal tumors with possible external sphincter involvement.

摘要

目的

正电子发射断层扫描/磁共振（PET/MR）在评估直肠癌局部范围中的作用仍不确定。本研究旨在探讨 PET/MR 与磁共振（MR）在临床分期直肠癌中的可能作用。

方法

本回顾性的、在两个中心进行的队列研究纳入了 62 例未经治疗的直肠癌患者，研究了基线分期 PET/MR 与单独的 MR 在确定临床分期方面的可能作用。两位读者评估了 T 和 N 分期、直肠系膜筋膜受累、肿瘤长度、距肛缘的距离、肛门括约肌受累和壁外血管侵犯（EMVI）。直肠镜检查、数字直肠检查以及随访影像学检查，以及在有条件的情况下进行手术，作为参考标准。

结果

与 MR 相比，PET/MR 在评估肿瘤大小（根据参考标准为 42.5 ± 21.03mm，单独的 MR 为 54 ± 20.45mm，而 PET/MR 为 44 ± 20mm，P=0.004）和识别 N 状态（MR 正确的为 62 例中的 36 例[58%]，而 PET/MR 为 49 例中的 49 例[79%]；P=0.02）和外部括约肌浸润（MR 正确的为 10 例中的 6 例，而 PET/MR 为 10 例中的 9 例；P=0.003）方面表现更优。在其他任何特征方面，没有观察到统计学上的显著差异。