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目的探讨MRI在直肠癌新辅助治疗后对直肠系膜筋膜(MRF)的评估价值。方法对40例局部进展期直肠癌新辅助治疗前后均行盆腔MRI扫描。以T_2WI对MRF进行描述,分析新辅助治疗前后MRF征象的变化规律,并比较不同方位MRF的征象变化有无差异。结果新辅助治疗后,12例MRF发生征象改变。前方和后方MRF征象变化率并无统计学差异(P<0.05)。对不同征象与预测病理MRF是否受累进行关联,并采用两种主观判断方法,其中方法Ⅰ敏感度和阴性预测值均低于方法Ⅱ(50.00%vs91.67%、81.82%vs96.15%)。方法Ⅰ特异度、阳性预测值稍高于方法Ⅱ(96.43%vs89.29%、85.71%vs78.57%)。根据方法Ⅰ和方法Ⅱ的诊断参数绘制ROC曲线,计算得出方法Ⅰ的曲线下面积(AUC)为0.732,方法Ⅱ的AUC为0.905对于新辅助治疗后MRF的评估,方法Ⅱ的诊断效能较方法Ⅰ更加准确(P<0.05)。结论在直肠癌新辅助治疗前后,MRI可以较为准确地描述MRF征象特点,对预测病理MRF是否受累有重要的临床价值。
Objective To evaluate the value of MRI in the detection of mesorectum fascia (MRF) after neoadjuvant treatment of rectal cancer. Methods Forty cases of locally advanced rectal cancer were treated with pelvic MRI before and after neoadjuvant therapy. The T_2WI was used to describe MRF. The changes of MRF before and after neoadjuvant therapy were analyzed. The changes of MRF in different directions were compared. Results After neoadjuvant therapy, signs of MRF in 12 cases were changed. There was no significant difference in MRF changes between the front and the rear (P <0.05). Two different subjective judgments were used to correlate the different signs and predictors of MRF. Method I sensitivity and negative predictive value were lower than those of method II (50.00% vs 91.67%, 81.82% vs 96.15%, respectively). Method Ⅰ specificity, positive predictive value slightly higher than the method Ⅱ (96.43% vs89.29%, 85.71% vs78.57%). The ROC curve was drawn according to the diagnostic parameters of method I and method II, and the area under the curve (AUC) of method I was 0.732 and the AUC of method II was 0.905. For MRF after neoadjuvant therapy, the diagnostic efficiency of method II was higher than that of method Ⅰ is more accurate (P <0.05). Conclusion Before and after neoadjuvant treatment of rectal cancer, MRI can describe the characteristics of MRF accurately and has important clinical value in predicting whether MRF is involved or not.