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直肠印戒细胞癌:MRI对放化疗后的评估及其与病理的对照

Rectal Signet Ring Cell Carcinoma: Post-Chemoradiotherapy Evaluation by MRI and Corresponding to Pathology.

作者信息

Zhou Yin, Li Qingshu, Mao Yun

机构信息

Department of Radiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Department of Pathology, School of Basic Medicine, Chongqing Medical University, Chongqing, China.

出版信息

Front Surg. 2022 Mar 4;9:841645. doi: 10.3389/fsurg.2022.841645. eCollection 2022.

Abstract

BACKGROUND

Signet ring cell carcinoma (SRCC) is recognized as an uncommon subtype of colorectal carcinoma (CRC). It showed characteristic magnetic resonance imaging (MRI) manifestations. However, the MRI features post-chemoradiotherapy (CRT) were not reported, and it is unknown whether the current tumor regression grade (TRG) system by MRI (mrTRG) is applicable to SRCC.

PURPOSE

To summarize the image features of rectal SRCC on post-CRT images corresponding to the pathology, and to determine the predicting value of mrTRG compared with TRG by pathology (pTRG).

METHODS

We retrospectively enrolled seven patients (male: female = 3:4; mean age, 45.1 years) with biopsy-pathology proved SRCC, who underwent pre- and post-CRT MR imaging followed by surgery. An experienced gastrointestinal radiologist accessed mrTRG using a 5-point grading system by mandard standard on T2 weighted image (T2WI) and then added diffusion weighted image (DWI) in a 1-month interval. Additionally, MRI features were recorded on pre- and post-CRT images as follows: pattern (target sign) and main signal intensity of T2WI, characterized manifestation of DWI, and mean Apparent Diffusion Coefficient (ADC)values. The mrTRG and all MR image features were compared to the post-operative pathology.

RESULTS

At post-CRT histology, five patients got a good response (TRG 1, n = 4; TRG 2, n = 1), one patient got a partial response, and one patient got a poor response. The accuracy of MRI predicted the pathology response by mandard standard was 14% and increased to 71.4% when added DWI. After CRT, different degrees of homogeneous high SI without enhancement representing acellular mucin were observed in all patients, and the thick-ring high SI turned into a thin-target sign in most good responders. Moreover, the tumor volume decreased or slightly increased in good responders, while it markedly increased in the partial and poor responder by 57% and 73.8%, respectively.

CONCLUSION

Homogeneous high SI on T2WI and thin target sigh on DWI were the main MRI changes of RSRCC, which was corresponding to the mucinous regression and represents for good response post-CRT. The mrTRG and tumor volume was not a reliable indicator to the pathology response. We considered that DWI should be added to T2WI to evaluate RSRCC response to CRT.

摘要

背景

印戒细胞癌(SRCC)是结直肠癌(CRC)中一种罕见的亚型。它具有特征性的磁共振成像(MRI)表现。然而,放化疗(CRT)后的MRI特征尚未见报道,目前基于MRI的肿瘤退缩分级系统(mrTRG)是否适用于SRCC也尚不清楚。

目的

总结直肠SRCC在放化疗后图像上与病理相对应的影像特征,并确定mrTRG与病理肿瘤退缩分级(pTRG)相比的预测价值。

方法

我们回顾性纳入了7例经活检病理证实为SRCC的患者(男∶女 = 3∶4;平均年龄45.1岁),这些患者在放化疗前后均接受了MR成像,随后接受了手术。一位经验丰富的胃肠放射科医生按照标准在T2加权像(T2WI)上使用5分制分级系统评估mrTRG,然后在1个月的间隔内增加扩散加权像(DWI)进行评估。此外,在放化疗前后的图像上记录MRI特征如下:T2WI的模式(靶征)和主要信号强度、DWI的特征性表现以及平均表观扩散系数(ADC)值。将mrTRG和所有MR图像特征与术后病理结果进行比较。

结果

放化疗后的组织学检查显示,5例患者反应良好(TRG 1,4例;TRG 2,1例),1例患者部分缓解,1例患者反应较差。按照标准,MRI预测病理反应的准确率为14%,增加DWI后准确率提高到71.4%。放化疗后,所有患者均观察到不同程度的均匀高信号且无强化,代表无细胞黏液,大多数反应良好的患者中厚环高信号转变为薄靶征。此外,反应良好的患者肿瘤体积减小或略有增加,而部分缓解和反应较差的患者肿瘤体积分别显著增加57%和73.8%。

结论

T2WI上的均匀高信号和DWI上的薄靶征是直肠SRCC的主要MRI变化,这与黏液退缩相对应,代表放化疗后反应良好。mrTRG和肿瘤体积并不是病理反应的可靠指标。我们认为在评估直肠SRCC对放化疗的反应时,应在T2WI基础上增加DWI。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/d63b/8930837/cb7dc38cdbf8/fsurg-09-841645-g0001.jpg

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