姚灵君　赵柳燕　颜桂明　陈国付▲　张飞燕

1.杭州市余杭区第一人民医院放射科，浙江杭州　311100；2.浙江省肿瘤医院放疗科，浙江杭州　310022

磁共振成像在直肠癌术前局部分期中的应用价值

姚灵君1赵柳燕1颜桂明2陈国付2▲张飞燕2

1.杭州市余杭区第一人民医院放射科，浙江杭州311100；2.浙江省肿瘤医院放疗科，浙江杭州310022

目的探讨磁共振成像（MRI）在直肠癌术前TN分期中的应用价值。方法回顾性分析2014年6月～2015年4月经手术病理证实的56例直肠癌患者的MRI影像资料，统计其典型影像学表现，局部组织浸润情况，并与术后病理对照分析。结果直肠癌局部分期中，患者MRI的T分期与病理分期结果的一致性检验Kappa值为0.771，有统计学意义（u=6.341，P＜0.01），T分期的准确度为85.7%（48/56）。MRI对N分期的灵敏度为89.4%（34/38），特异度为88.9%（16/18），准确度为69.6%（39/56）。其中T4的准确度最高（88.2%），N2的准确度最低（61.5%）。结论MRI对直肠癌术前局部分期有很高的临床价值，T分期准确度较高，对是否有淋巴结转移的灵敏度和特异度尚可，具体分期诊断的准确度略低。

直肠癌；磁共振成像；肿瘤分期；术前评估

［Abstract］Objective To explore the value ofmagnetic resonance imaging（MRI）in TN staging of colorectal cancer before surgery.M ethods A total of 56 cases of colorectal cancer patients confirmed by surgical pathology from June 2014 to April 2015 were retrospectively analyzed for their MRI data.The typical imaging findings and the local tissue infiltration of the cancer were statistically analyzed and compared to the post-operative pathology of the cancer.Results A-mong the local staging of colorectal cancer，the Kappa value of the consistency test between the T staging by MRIand pathological staging for the patients was 0.771 and with statistical significance（u=6.341，P＜0.01）.The accuracy of T staging was 85.7%（48/56）.The sensitivity，specificity and accuracy of N staging by MRIwere 89.4%（34/38），88.9%（16/ 18）and 69.6%（39/56），respectively.The accuracy of T4 was highest（88.2%）and the accuracy of N2 was lowest（61.5%）. Conclusion MRI is of high clinical value for the local staging of colorectal cancer before surgery.T staging by MRI is of higher accuracy，moderate sensitivity and specificity to determine whether there is lymphatic metastasis and slightly lower accuracy for the staging of tumor.

［Key words］Colorectal cancer；Magnetic resonance imaging；Neoplasms staging；Preoperative evaluation

直肠癌发生于齿状线至直肠乙状结肠交界处之间，是消化道最常见的恶性肿瘤之一。近年来我国直肠癌发病率有明显上升趋势，发病年龄呈年轻化，以大城市尤为明显［1］。目前基本公认的是动物脂肪和蛋白质摄入过高、食物纤维摄入不足为直肠癌发生的高危因素。术前对其准确评价、正确分期，对患者的综合治疗以及预后有重要的意义［2］。本研究回顾性分析经术后病理证实的56例直肠癌患者的磁共振影像资料，旨在探讨磁共振成像（MRI）在直肠癌术前诊断TN分期中的应用价值。……