中国实用外科杂志 ›› 2010, Vol. 30 ›› Issue (10): 831-834.

• 专家论坛 • 上一篇    下一篇

CT与MRI在直肠癌分期诊断中的应用

张晓鹏,孙应实   

  1. 北京大学肿瘤医院暨北京市肿瘤防治研究所,医学影像科,恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142
  • 出版日期:2010-10-01 发布日期:2010-09-28

  • Online:2010-10-01 Published:2010-09-28

摘要:

直肠癌是消化道系统常见恶性肿瘤,依据直肠癌的不同分期采用不同的治疗方法,术前准确判断直肠癌分期是合理制定治疗方案的关键。目前,在国内用于直肠癌术前分期的影像学检查方法主要有CT、MRI和超声内镜。任何一种影像检查方法都有其自身的优势和不足,没有哪种方法可以对直肠癌分期的各个方面的诊断均作出满意的回答。直肠癌T分期,目前较好的影像学检查方法主要是腔内超声和MRI,尤其是T分期较早病例,腔内超声分期更准确,进展期直肠癌和N分期,MRI有一定优势。对于M分期,CT和MRI都能满足临床需要,但CT对于腹部其他结构的显示更清晰,同时,还可以一次完成腹、盆腔检查。MRI具有较好的T、N分期能力的同时,还可以准确显示直肠癌TME手术相关的精细解剖结构,准确评估癌肿边缘与直肠系膜筋膜、肛门及盆腔腹膜反折等邻近解剖结构的关系,对于决定治疗方案和TME手术效果价值较大。

关键词: 直肠癌, 超声内镜, 计算机断层成像, 磁共振成像

Abstract:

CT and MRI in the diagnosis of rectal cancer staging ZHANG Xiao-peng, SUN Ying-shi. Key Laboratory of Carcinogenesis and Translational Research, Department of Radiology, Cancer Hospital & Institute of Peking University, Beijing 100142, China
Correspondin author: ZHANG Xiao-peng, E-mail:zxp@bjcancer.org
Abstract    Rectal cancer is one of the most common causes of death from cancer. Accurate staging is necessary for optimal treatment. Preoperative staging is an essential factor in the multidisciplinary management of rectal cancer now because tumor stage is the strongest predictive factor for recurrence. The tumor node metastasis (TNM) system is used to describe numerically the anatomical extent of cancer. Various diagnostic methods provide accurate staging. Endorectal ultrasound (EUS) and magnetic resonance tomography  are suitable for determining tumor T stage. US is better for T1~2 stage tumor especially. Moreover, MRI has some advantages in T and N stage of advanced rectal cancer. Modern multidetector row CT is predestined for detecting distant metastases as it is a widespread, fast, and reproducible method. MRI is highly accurate in predicting the circumferential resection margin. MRI provides accurate assessment of the tumor relative to the circumferential margin, that is, the mesorectal fascia, the anal and pelvic peritoneal fold, which is valuable for determining therapy protocol and therapy outcome.

Key words: rectal cancer, endorectal ultrasound, CT, MRI