摘要
目的 探讨MRI对结直肠癌检查的可行性及其价值。方法 对 38例经临床拟诊为结直肠癌患者行MR检查 ,检查前经直肠灌水 30 0～ 10 0 0ml。分别行轴面平扫 ,轴面、矢状面和冠状面3个平面增强扫描及水成像。结果 38例中经手术病理证实的结直肠癌 31例 ,5例表现为腔内局限性软组织肿块 ,2 6例表现为肠壁不规则增厚 ,肠腔环形狭窄环绕肠腔 1周或部分 ,平扫T1WI上呈等信号 ,T2 WI上 30例呈略高信号 ,1例呈明显高信号 ;钆喷替酸葡甲胺 (Gd DTPA)增强扫描病灶均明显强化。 5例平扫SE序列T1WI上病灶周围脂肪间隙内见斑片状低信号。增强后病变段肠壁外缘光滑 12例 ,不光滑或有结节影向外突出 19例。结直肠水成像满意的 2 4例中显示为病变部位肠腔内不规则充盈缺损 14例 ,10例病变远侧端呈“袖口征”及“截断征” ,近侧端未显示。MRI可以正确识别 31例经病理证实的结直肠癌中的 30例和 7例非结直肠癌中的 4例 ,诊断的敏感度、特异度和准确度分别为96 8%、5 7 1%和 89 5 %。MRI对结直肠癌T分期的准确度为 83 9%( 2 6 / 31) ,其中对T1～ 2期为75 0 %( 9/ 12 )、对T3期为 88 2 %( 15 / 17)、对T4期为 10 0 %( 2 / 2 )。结论 MRI可以从整体上显示结直肠癌的纵向和横向侵犯 。
Objective To explore the feasibility and value of MRI examination in colorectal carcinoma. Methods Thirty-eight patients with clinically suspected colorectal carcinoma were included in this study and all of them underwent MRI examination. About 300- 1 000 ml water was administered transrectally before scanning. Axial plain scan, three-planar enhanced scan and hydrography were performed, respectively. Results In 38 patients, 31 cases were pathologically proved as colorectal carcinoma. The main MRI findings were: intraluminal soft tissue mass (n=5), irregular thickening of colorectal wall and partial or circumferential stenosis of colorectal lumen (n=26). The tumors were all demonstrated as medium signal intensity on T 1-weighted images. Thirty of 31 cases showed slightly hyperintensity and one was conspicuous high signal intensity on T 2-weighted images. Marked enhancement was demonstrated in all foci. Focal low signal structures were presented in the pericolorectal fat on precontrast T 1-weighted SE sequence in 5 cases. Smooth margins were revealed in 12 cases and irregular and/or nodular margins of peripheral wall in 19 cases. Colorectal hydrography showed that there were intraluminal irregular filling defects (n=14), and that 'cuff sign' or 'sawn-off sign' was demonstrated in the distal end of tumor and its proximal part couldn't be seen (n=10). Thirty of 31 patients with pathologically proved colorectal carcinoma and 4 of 7 patients with non-colorectal carcinoma were correctly identified by MRI. The sensitivity, specificity, and accuracy were 96.8%, 57.1%, and 89.5%, respectively. The accuracy of MRI in T staging was 83.9% (26/31). The accuracy in T1-2, T3, and T4 staging was 75.0% (9/12), 88.2% (15/17), and 100% (2/2), respectively. Conclusion MRI could clearly show the longitudinal and horizontal invasion of colorectal carcinoma as a whole. It could accurately determine the invasive depth of local lesions. Barium enema examination may be partially replaced by colorectal hydrography with MIP reconstruction. It is of directorial value in clinical treatment.
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2003年第5期422-427,共6页
Chinese Journal of Radiology
