Technol Health Care. 2024;32(2):615-627. doi: 10.3233/THC-220798.
Surgery is the preferred treatment for rectal cancer, but surgical treatment alone sometimes does not achieve satisfactory results.
To explore the value of multimodal Magnetic Resonance (MR) images in evaluating T staging of rectal cancer after neoadjuvant therapy and to compare and analyze with pathological results.
This study retrospectively analyzed 232 patients with stage T3, T4 rectal cancer between January 1, 2017 and October 31, 2022. MR examination was performed within 3 days before surgery. Different MR sequences were used for mrT staging of rectal cancer after neoadjuvant therapy and compared with pathological pT staging. The accuracy of different MR sequences in evaluating T staging of rectal cancer was calculated, and the consistency between the two was analyzed by kappa test. The sensitivity, specificity, negative predictive value and positive predictive value of different MR sequences in evaluating rectal cancer invading mesorectal fascia after neoadjuvant therapy were calculated.
A total of 232 patients with rectal cancer were included in the study. The accuracy of high-resolution T2 WI in evaluating T staging of rectal cancer after neoadjuvant therapy was 49.57%, and the Kappa value was 0.261. The accuracy of high-resolution T2WI combined with diffusion weighted imaging (DWI) in evaluating T staging of rectal cancer after neoadjuvant therapy was 61.64%, and the Kappa value was 0.411. The accuracy of high-resolution combined with DCE-MR images in evaluating T staging of rectal cancer after neoadjuvant therapy was 80.60%, and the Kappa value was 0.706. The sensitivity and specificity of high-resolution t2-weighted imaging (HR-T2WI) combined with dynamic contrast-enhancement magnetic resonance (DCE-MR) in evaluating the invasion of mesorectal fascia were 83.46% and 95.33%, respectively.
Compared with HR-T2WI combined with DWI images for mrT staging of rectal cancer after neoadjuvant chemoradiotherapy (N-CRT), HR-T2WI combined with DCE-M has the highest accuracy in evaluating mrT staging of rectal cancer after neoadjuvant therapy (80.60%), and has a high consistency with pathological pT staging. It is the best sequence for T staging of rectal cancer after neoadjuvant therapy. At the same time, the sequence has high sensitivity and specificity in evaluating mesorectal fascia invasion, which can provide accurate perioperative information for the formulation of surgical plan.
手术是治疗直肠癌的首选方法，但单纯手术治疗有时并不能达到满意的效果。
探讨多模态磁共振成像（MR）在评价新辅助治疗后直肠癌 T 分期中的价值，并与病理结果进行比较分析。
本研究回顾性分析了 2017 年 1 月 1 日至 2022 年 10 月 31 日期间 232 例 T3、T4 期直肠癌患者。所有患者术前 3 天内行 MR 检查。采用不同的 MR 序列对新辅助治疗后直肠癌的 mrT 分期进行评估，并与病理 pT 分期进行比较。计算不同 MR 序列评估新辅助治疗后直肠癌 T 分期的准确性，并采用 Kappa 检验分析两者的一致性。计算不同 MR 序列评价新辅助治疗后直肠癌侵犯直肠系膜筋膜的敏感性、特异性、阴性预测值和阳性预测值。
本研究共纳入 232 例直肠癌患者。高分辨率 T2WI 评估新辅助治疗后直肠癌 T 分期的准确性为 49.57%，Kappa 值为 0.261。高分辨率 T2WI 联合弥散加权成像（DWI）评估新辅助治疗后直肠癌 T 分期的准确性为 61.64%，Kappa 值为 0.411。高分辨率联合动态对比增强磁共振成像（DCE-MR）图像评估新辅助治疗后直肠癌 T 分期的准确性为 80.60%，Kappa 值为 0.706。高分辨率 T2WI 联合 DCE-MR 评价直肠系膜筋膜侵犯的敏感性和特异性分别为 83.46%和 95.33%。
与新辅助放化疗（N-CRT）后 HR-T2WI 联合 DWI 图像用于直肠癌 mrT 分期相比，HR-T2WI 联合 DCE-M 对新辅助治疗后直肠癌 mrT 分期的评估具有最高的准确性（80.60%），与病理 pT 分期具有较高的一致性。它是新辅助治疗后直肠癌 T 分期的最佳序列。同时，该序列在评价直肠系膜筋膜侵犯方面具有较高的敏感性和特异性，可为手术方案的制定提供准确的围手术期信息。
