Guinet C, Buy J N, Sezeur A, Mosnier H, Ghossain M, Malafosse M, Guivarc'h M, Vadrot D, Ecoiffier J
Service de Radiologie, Hotel Dieu de Paris, France.
J Comput Assist Tomogr. 1988 Mar-Apr;12(2):209-14. doi: 10.1097/00004728-198803000-00006.
Nineteen patients with rectal carcinoma were evaluated prospectively. The extent of tumor and the relationship of the tumor to the levator ani muscle were studied as this determines the choice of the surgical procedure (abdominoperineal resection versus low anterior resection). Peroperative assessment and detailed evaluation of the pathologic specimens were correlated with magnetic resonance (MR) features. Magnetic resonance staging and surgical findings were at variance in four of 15 cases (27%). Magnetic resonance had sensitivities and specificities of 75 and 100% in the detection of perirectal growth. Magnetic resonance demonstrated invasion of adjacent pelvic side wall and sacrum in two of two cases. The comparison with TNM classification demonstrated that MR correctly staged 15 of 19 cases (79%). This study shows that MR is a good examination to evaluate the involvement of perirectal fatty tissues and adjacent structures. The low prevalence of involved lymph nodes in our cases prevents significant positive predictive values. Nevertheless, MR can help to select patients for local excision or for preoperative radiotherapy.
对19例直肠癌患者进行了前瞻性评估。研究了肿瘤范围以及肿瘤与肛提肌的关系，因为这决定了手术方式的选择（腹会阴联合切除术与低位前切除术）。将术中评估和病理标本的详细评估与磁共振（MR）特征进行了对比。15例中有4例（27%）磁共振分期与手术结果不一致。磁共振检测直肠周围生长的敏感性和特异性分别为75%和100%。磁共振在2例患者中均显示出邻近盆腔侧壁和骶骨受侵。与TNM分类的比较表明，MR对19例中的15例（79%）进行了正确分期。本研究表明，MR是评估直肠周围脂肪组织和邻近结构受累情况的良好检查方法。我们病例中受累淋巴结的低发生率使得阳性预测值不高。尽管如此，MR有助于选择适合局部切除或术前放疗的患者。
