Sofic Amela, Husic-Selimovic Azra, Efendic Alma, Sehic Adnan, Julardzija Fuad, Cizmic Midhat, Beslagic Eldina, Aladjuz-Granov Lejla
Department of Radiology, General Hospital "Prim.dr.Abdulah Nakaš" Sarajevo, Bosnia and Herzegovin.
Department of Internal medicine, General Hospital "Prim.dr.Abdulah Nakaš", Sarajevo, Bosnia and Herzegovina.
Acta Inform Med. 2021 Jun;29(2):113-117. doi: 10.5455/aim.2021.29.113-117.
EMVI is a direct invasion of a vein by a tumor. As a predictor of hematogenous metastasis, it is a poor prognostic factor in rectal cancer and can be accurately identified on MRI prior to surgical procedure.
To evaluate the role of contrast-enhanced T1-weighted magnetic resonance imaging (CET1WI) in addition to high-resolution T2-weighted imaging (HRT2WI) in assessing extramural venous invasion (EMVI) of rectal cancer.
In all 195 patients with rectal cancer, HRT2WI and CET1WI sequences were produced within pre-operative MRI for the purpose of assessing for the presence of EMVI (mrEMVI). CET1WI sequences were produced following administration of Gadolinium contrast medium. mrEMVI assessment results were classified into two groups. Group A consisted of mrEMVI assessment results obtained using HRT2WI sequences only. Group B consisted of mrEMVI assessment results obtained using a combination of HRT2WI + CET1WI sequences. Results obtained for each group (A and B) were correlated with a histopathological finding (pEMVI) as a reference standard.
Out of a total of 195 rectal cancer patients, mrEMVI was positive in 41 (21%) patients in group A, and in 45 (23%) patients in group B. Histopathological finding demonstrated pEMVI in 54 (27.7%) patients. A statistical analysis of group A (HRT2WI sequences) resulted in 75.9% sensitivity to mrEMVI and 96.4% specificity, Positive Predictive Value of 89.1% and Negative Predictive Value of 91.2% (95% confidence interval (CI), p< 0.05). Statistical analysis of group B (HRT2WI + CET1WI sequences) resulted in 83.3% sensitivity to mrEMVI and 98.5% specificity, Positive Predictive Value of 89.1% and Negative Predictive Value of 91.2% (CI 95%, p< 0.05).
T1-weighted magnetic resonance imaging (CET1WI) in addition to high-resolution T2-weighted imaging (HRT2WI) increased evaluation of extramural venous invasion (EMVI) of rectal cancer.
肠壁外静脉侵犯（EMVI）是指肿瘤直接侵犯静脉。作为血行转移的预测指标，它是直肠癌预后不良的因素，并且在手术前通过磁共振成像（MRI）能够准确识别。
评估除高分辨率T2加权成像（HRT2WI）外，对比增强T1加权磁共振成像（CET1WI）在评估直肠癌肠壁外静脉侵犯（EMVI）中的作用。
在195例直肠癌患者中，术前MRI检查时均采用HRT2WI和CET1WI序列，以评估肠壁外静脉侵犯（mrEMVI）情况。CET1WI序列在静脉注射钆对比剂后采集。mrEMVI评估结果分为两组。A组为仅使用HRT2WI序列获得的mrEMVI评估结果。B组为使用HRT2WI + CET1WI序列组合获得的mrEMVI评估结果。将每组（A组和B组）获得的结果与作为参考标准的组织病理学结果（pEMVI）进行相关性分析。
在195例直肠癌患者中，A组41例（21%）患者mrEMVI为阳性，B组45例（23%）患者mrEMVI为阳性。组织病理学结果显示54例（27.7%）患者存在pEMVI。对A组（HRT2WI序列）的统计分析显示，对mrEMVI的敏感性为75.9%，特异性为96.4%，阳性预测值为89.1%，阴性预测值为91.2%（95%置信区间（CI），p < 0.05）。对B组（HRT2WI + CET1WI序列）的统计分析显示，对mrEMVI的敏感性为83.3%，特异性为98.5%，阳性预测值为89.1%，阴性预测值为91.2%（95%CI，p < 0.05）。
除高分辨率T2加权成像（HRT2WI）外，对比增强T1加权磁共振成像（CET1WI）提高了对直肠癌肠壁外静脉侵犯（EMVI）的评估。
