应用容积加速采集增强序列提高放化疗后评估器官侵犯性直肠黏液腺癌准确性的研究

Application of liver acquisition with volume acceleration enhanced sequence in improving the accuracy of reassessing organ-invasive rectal mucinous adenocarcinoma after chemoradiation.

机构信息

Department of Radiology, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China; Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, 510655, China.

Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Disease, Guangzhou, 510655, China; Department of Gastrointestinal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510655, China.

出版信息

Eur J Radiol. 2020 Dec;133:109368. doi: 10.1016/j.ejrad.2020.109368. Epub 2020 Oct 26.

DOI:10.1016/j.ejrad.2020.109368

PMID:33207287

Abstract

OBJECTIVES

To explore the ability of liver acquisition with volume acceleration contrast-enhanced sequence (LAVA-ce) to improve the accuracy of reassessing adjacent organ involvement by rectal mucinous adenocarcinoma (MC) after neoadjuvant therapy (NAT).

METHODS

This study retrospectively enrolled twenty-five patients with MC who underwent pre- and post-NAT MRI, were staged as T4b using pre-NAT T weighted imaging, received NAT and underwent radical resection. All MR images were divided into two schemes, T weighted plus diffusion weighted imaging (TD protocol) and plus LAVA-ce (TDL protocol). All patients were scored on a 0-4 scale to reassess organ-invasive mucus components. Postoperative pathology was used to identify the involvement of surrounding organs (ypT4b). The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to evaluate the consistency of the results with pathology after adding fs-CE sequence.

RESULTS

Among 25 MC patients (15 males and 10 females, aged 21-89 years), 21 were restaged as yT4b after NAT by using TD, with an accuracy of 44.0 % (11/25), which was lower than the accuracy of staging patients with non-mucinous rectal adenocarcinoma (94.1 %, 96/102). The accuracy of MC restaging was improved by using TDL (23/25). The AUC of TDL was 0.857 (95 % CI, 0.660∼0.964), which was higher than that of TD (AUC, 0.611 [95 % CI, 0.397∼0.798]) (P = 0.019).

CONCLUSION

The LAVA-ce sequence can improve the accuracy of reevaluation and should be included in the MRI protocol for MC patients.

摘要

目的

探讨容积加速采集对比增强序列（LAVA-ce）在评估直肠癌黏液腺癌（MC）新辅助治疗（NAT）后邻近器官受累的准确性方面的作用。

方法

本研究回顾性纳入 25 例接受过术前和术后 NAT MRI 检查、术前 T 加权成像（TWI）分期为 T4b 且接受过 NAT 并接受根治性切除的 MC 患者。所有 MR 图像分为两种方案，即 T 加权加弥散加权成像（TD 方案）和加 LAVA-ce（TDL 方案）。所有患者均按 0-4 分对评估器官侵袭性黏液成分进行评分。术后病理用于确定周围器官的受累情况（ypT4b）。受试者工作特征（ROC）曲线和曲线下面积（AUC）用于评估在添加 fs-CE 序列后与病理结果的一致性。

结果

在 25 例 MC 患者（15 例男性，10 例女性；年龄 21-89 岁）中，21 例患者经 NAT 后 T 分期为 yT4b，采用 TD 方案的准确率为 44.0%（11/25），低于非黏液性直肠腺癌患者（94.1%，96/102）。采用 TDL 方案可提高 MC 分期的准确率（23/25）。TDL 的 AUC 为 0.857（95%CI，0.660-0.964），高于 TD 的 AUC（0.611，95%CI，0.397-0.798）（P=0.019）。