摘要
直肠癌是我国最常见的恶性肿瘤之一,其发病率和死亡率均呈逐年上升趋势。淋巴结转移(lymph node metastasis,LNM)作为直肠癌转移的主要方式之一,与患者的分期和预后密切相关,因此准确评估淋巴结状态对于患者的诊疗至关重要。目前美国国立综合癌症网络指南推荐直肠癌患者行MRI检查以评估淋巴结状态,但常规MRI形态学特征诊断LNM的准确性仍有待提高,尚不能满足临床对直肠癌精准诊疗的需求。功能性MRI技术及人工智能有望在直肠癌淋巴结评估方面展现较好的预测价值,然而尚缺乏全面总结二者新近研究的综述。因此,本文就直肠癌LNM的途径、常规形态及功能性MRI技术,以及人工智能在直肠癌淋巴结评估方面近年来的进展进行综述,以期帮助读者了解目前评估直肠癌淋巴结状态的现状以及未来发展方向。笔者认为,未来研究可聚焦于挖掘新的形态学特征,进一步优化功能性MRI技术和人工智能算法,规范化扫描参数和诊断模型,并在建立多中心、大样本的直肠癌MRI数据库后进行验证,促进各种诊断工具的临床转化,以辅助医生精准诊断直肠癌LNM与制订个体化治疗方案。
Rectal cancer is one of the most common malignant tumors in China,with both its incidence and mortality rates demonstrating a consistent upward trend in recent years.Lymph node metastasis(LNM),as one of the primary metastatic pathways in rectal cancer,is closely associated with disease staging and patient prognosis.Therefore,accurate assessment of lymph node status is critical for guiding clinical management.The current National Comprehensive Cancer Network guidelines recommend MRI for assessing lymph node status in patients with rectal cancer.However,the diagnostic accuracy of conventional MRI morphological features in identifying LNM remains suboptimal and insufficient to meet clinical demands for precision diagnosis and treatment of rectal cancer.Emerging functional MRI techniques and artificial intelligence demonstrate considerable potential in enhancing predictive capabilities for lymph node evaluation,yet a comprehensive review of recent advances in these fields is still lacking.This review systematically examines the metastatic pathways of lymph nodes,conventional and functional MRI techniques,and artificial intelligence applications in lymph node assessment in rectal cancer.It aims to provide readers with insights into current assessment approaches and future directions.We suggest that future studies should prioritize the discovery of novel morphological biomarkers,refinement of functional MRI techniques and artificial intelligence algorithms,standardization of imaging protocols and diagnostic models,and validation through multi-center studies with large-scale rectal cancer MRI databases.These advancements may accelerate the clinical translation of diagnostic tools,ultimately aiding clinicians in achieving precise diagnosis of LNM and tailoring personalized therapeutic strategies for rectal cancer patients.
作者
李帝良
万丽娟
张红梅
LI Diliang;WAN Lijuan;ZHANG Hongmei(Department of Diagnostic Radiology,National Cancer Center,National Clinical Research Center for Cancer,Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)
出处
《磁共振成像》
北大核心
2025年第7期185-191,共7页
Chinese Journal of Magnetic Resonance Imaging
基金
国家自然科学基金项目(编号:82402229)
中国医学科学院医学与健康科技创新工程项目(编号:2024-I2M-C&T-A-007)
北京协和医学院中央高校基本科研项目(编号:3332024050)
北京协和医学院课程思政教改项目(编号:2024KCSZ019)。
关键词
直肠癌
淋巴结转移
磁共振成像
临床诊疗
影像研究
rectal cancer
lymph node metastasis
magnetic resonance imaging
clinical management
imaging research
