High-resolution MR imaging for nodal staging in rectal cancer: are there any criteria in addition to the size?
High-resolution MR imaging for nodal staging in rectal cancer: are there any criteria in addition to the size?
复制标题
DOI：
10.1016/j.ejrad.2003.12.005
复制
发表时间：
2004-10-01
影响因子：
3.3
通讯作者：
Beets-Tan, RGH
中科院分区：
文献类型：
--
作者：
Kim, JH;Beets, GL;Beets-Tan, RGH
目的：直肠癌患者淋巴结转移的MR分期很难根据大小、形状和信号强度进行，因为大于或等于50%的淋巴结大小小于5 mm。因此，新的MR标准进行了评估，看看它是否可以改善直肠癌患者淋巴结转移的MR评估。材料和方法：99例原发性直肠癌患者接受了1.5T高分辨率MRI，采用正交相控阵线圈。其中，75例患者接受了全直肠系膜切除术。MR放射科医生对组织学结果不知情，随机记录每个可检测淋巴结（LN）的特征;共同标准，如短轴直径，长轴与短轴直径的比值，以及每个序列上的信号强度;新的标准，例如（光滑，分叶状，毛刺状，不清楚），均匀或斑点状不均匀外观，大体增强及其模式，静脉包裹，和脏的直肠周围脂肪信号结果：75例患者中，22例（29%）淋巴结阳性。所有在MR上未检测到LN的患者均无淋巴结（n = 15）。淋巴结阳性组中淋巴结直径> 4 mm者明显增多。淋巴结> 8 mm仅见于淋巴结阳性组.毛刺状边缘和不明显边缘的敏感性分别为45%和36%，特异性分别为100%和100%。斑点状异质性模式的存在显示了50%的敏感性，95%的特异性。这三个特征的存在与LN阳性强相关（分别为P < 0.001）。静脉包绕（n = 4）和脏的直肠周围脂肪信号（n = 3）的存在也与LN阳性显著相关（分别为P < 0.05）。结论：除了大小，新的标准，如毛刺或边界模糊和斑驳的异质性外观可能是有用的，以预测区域淋巴结的直肠癌患者的参与。(C)2004爱思唯尔爱尔兰有限公司保留所有权利。
Purpose: MR staging of nodal metastases in patients with rectal cancer using criteria based on size, shape and signal intensity can be difficult, because greater than or equal to50% of the nodes are less than 5 mm in size. Therefore new MR criteria were evaluated to see whether it can improve the MR assessment of nodal metastases in rectal cancer patients. Materials and methods: Ninety-nine patients with primary rectal carcinoma underwent 1.5 T high-resolution MRI with a quadrature phased array coil. Among them, 75 patients who had undergone total mesorectal excision were enrolled in this study. An MR radiologist, blinded for the histological results, randomly recorded the characteristics of each detectable node (LN); common criteria such as short-axis diameter, the ratio of long- to short-axis diameter, and signal intensity on each sequence; new criteria such as the margin (smooth, lobulated, spiculated, indistinct), a homogenous or mottled heterogeneous appearance, gross enhancement and its pattern, the venous encasement, and the dirty perirectal fat signal. Results: Among 75 patients, 22 (29%) were node-positive. All patients who did not have detectable LN on MR were node-free (n = 15). Presence of LNs > 4 mm was significantly higher in the node-positive group. Presence of LNs > 8 mm was seen only in the node- positive group. Presence of a spiculated border and an indistinct border shows sensitivities of 45 and 36%, and specificities of 100 and 100%, respectively. Presence of a mottled heterogeneic pattern shows a sensitivity of 50%, a specificity of 95%. The presence of these three features were strongly correlated with LN positivity (P < 0.001, respectively). Presence of a venous encasement (n = 4) and dirty perirectal fat signal (n = 3) were also significantly (P < 0.05, respectively) correlated with LN positivity. Conclusion: In addition to size, new criteria such as a spiculated or indistinct border and a mottled heterogeneous appearance could be useful to predict regional lymph node involvement in patients with rectal cancer. (C) 2004 Elsevier Ireland Ltd. All rights reserved.