Barbaro B, Valentini V, Manfredi R
Istituto di Radiologia, Università Cattolica del S. Cuore, Policlinico A. Gemelli, Roma, Italy.
Rays. 1995 Apr-Jun;20(2):165-81.
The personal experience with the radiologic staging of high risk rectal cancer undergoing preoperative treatment is reported. 61 patients shown to be affected by locally advanced (T3-T4, N+with any T) rectal tumors on combined modality staging, underwent restaging 4-5 weeks after treatment. In all patients liver US, pelvic CT and colorectal enema were performed before and after treatment. In 22 patients with low rectal cancer transrectal sonography was performed. In 19 patients pelvic MRI was performed. The 61 patients were considered operable on second staging and thus referred to surgery. Subsequent control on histology has confirmed the diagnostic accuracy of the single procedures and of their combination. US was shown to be of high accuracy in the evaluation of T (90.8%) and of high predictive value for N. CT accuracy (84%) and MRI accuracy (78.9%) was lower because both tend to overstaging in the evaluation of T of rectal tumors undergoing preoperative treatment. Low CT accuracy (64%) and MRI accuracy (58%) was observed for N. There was optimum agreement between histology and imaging in the assessment of tumor shrinkage, well visualized by rectal enema which supported combined restaging with 88% accuracy for T.
本文报告了对接受术前治疗的高危直肠癌进行放射学分期的个人经验。61例经综合影像学分期显示为局部进展期（T3-T4，任何T分期的N+）直肠肿瘤的患者，在治疗后4-5周进行了重新分期。所有患者在治疗前后均进行了肝脏超声、盆腔CT和大肠灌肠检查。22例低位直肠癌患者进行了经直肠超声检查。19例患者进行了盆腔MRI检查。61例患者在二次分期时被认为可进行手术，因此转至外科治疗。随后的组织学对照证实了单一检查及其联合检查的诊断准确性。超声在评估T分期方面显示出高准确性（90.8%），对N分期具有高预测价值。CT准确性（84%）和MRI准确性（78.9%）较低，因为两者在评估接受术前治疗的直肠肿瘤的T分期时往往存在分期过高的情况。在评估N分期时，CT准确性（64%）和MRI准确性（58%）较低。在评估肿瘤缩小方面，组织学与影像学之间存在最佳一致性，直肠灌肠能很好地显示肿瘤缩小情况，其支持联合重新分期对T分期的准确性为88%。
