MRI减影技术结合DWI对直肠癌术前分期诊断的临床应用研究

目的：分析和研究MRI减影技术结合DWI在直肠癌术前TN分期的临床应用价值。方法：收集2010年8月~2013年12月期间经我院外科手术及病理证实的原发直肠癌患者53例。MRI序列包括常规TSE-T1WI、-T2WI、弥散成像（DWI）及反转恢复频率饱和成像（SPIR）序列。全部患者均行多方位增强扫描,而且保证有一个方位必须垂直肿块所在平面的肠管长轴,将增强扫描前后同方位图像进行减影处理,由两名高年资专家读片,并作术前TN分期。病理参考标准以Dukes分期为标准,并用Kappa方法检验MRI减影技术在直肠癌术前分期与病理结果一致性差异,统计学处理采用SPASS 19.0。结果：53例直肠癌患者中,MRI减影技术结合DWI对直肠癌检出率为100%,正确T分期49例,过低分期1例,过高分期3例,准确率为92.5%（49/53）,与病理结果一致性较好。按照MRI术前提示,手术切除淋巴结283枚,53例患者术后病检伴有淋巴结转移者36例,转移性淋巴结184枚,DWI结合常规序列术前评价淋巴结转移可靠性大。结论：MRI减影技术结合DWI方便、快捷,对直肠癌的诊断及术前TN分期准确性高,值得推广应用。

MRI Subtraction Technique Combining DWI for Colorectal Cancer Can Study the Clinical Application of Preoperative Staging Diagnosis

Objection： Analysis and research on MRI subtraction technology combined with the clinical value of DWI in preoperative TN staging of rectal cancer can. Methods： Collected during 2010.8-2013.12 by surgery and pathology confirmed in our primary 53 patients with rectal cancer, The selected patients were confirmed by colonoscopy biopsy for 46 cases of patients with rectal cancer, 7 cases of suspicious. Including conventional MRI sequence TSE-T1 WI, T2 WI, diffusion imaging（DWI） can imaging and inversion recovery frequency saturation（SPIR） sequence. All patients were multiple enhanced scan, and ensure that there is a bearing insufflate long axis of the plane must be perpendicular to the masses, to subtract the same level images of before and after enhancement scanning. By two high venture experts asked to read, and preoperative TN staging. Pathological reference standard is a standard with Dukes staging.MRI subtraction technique in colorectal cancer using Kappa. test preoperative staging and pathologic results consistency difference, statistical processing using SPASS19.0. Results： 53 patients for colorectal cancer, MRI subtraction technique combining DWI for colorectal cancer detection rate of 100%, can correct the T staging in 49 cases, low stage 1 case, high stage（3 cases）, T staging accuracy was 92.5%（49/53）. According to the preoperative MRI tips, surgical removal of lymph nodes 283, 53 patients with postoperative disease inspection in 36 cases with lymph node metastasis, 184 metastatic lymph nodes, DWI combined with conventional sequence can reliability evaluation of preoperative lymph node metastasis. Conclusion： MRI subtraction technique combining DWI convenient, quick, can in colorectal cancer diagnosis and preoperative TN staging accuracy is high, is worth popularization and application.