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中华医学超声杂志(电子版) ›› 2016, Vol. 13 ›› Issue (01) : 51 -55. doi: 10.3877/cma.j.issn.1672-6448.2016.01.013

所属专题: 文献

腹部超声影像学

直肠腔内弹性成像对直肠癌新辅助治疗后肿瘤浸润深度降期的评估
仲光熙1, 吕珂1, 戴晴1, 李建初1, 姜玉新1,()   
  1. 1. 100730 中国医学科学院 北京协和医学院 北京协和医院超声医学科
  • 收稿日期:2015-09-07 出版日期:2016-01-01
  • 通信作者: 姜玉新

Value of endorectal elastography for predicting the downstage of infiltration depth in rectal cancer after neoadjuvant radiochemotherapy

Guangxi Zhong1, Ke Lyu1, Qing Dai1, Jianchu Li1, Yuxin Jiang1,()   

  1. 1. Department of Ultrasonography, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
  • Received:2015-09-07 Published:2016-01-01
  • Corresponding author: Yuxin Jiang
  • About author:
    Corresponding author: Jiang Yuxin, Email:
引用本文:

仲光熙, 吕珂, 戴晴, 李建初, 姜玉新. 直肠腔内弹性成像对直肠癌新辅助治疗后肿瘤浸润深度降期的评估[J/OL]. 中华医学超声杂志(电子版), 2016, 13(01): 51-55.

Guangxi Zhong, Ke Lyu, Qing Dai, Jianchu Li, Yuxin Jiang. Value of endorectal elastography for predicting the downstage of infiltration depth in rectal cancer after neoadjuvant radiochemotherapy[J/OL]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2016, 13(01): 51-55.

目的

评估直肠腔内弹性成像应变比值(SR)判断直肠癌新辅助治疗后肿瘤浸润深度(T分期)降期的临床应用价值。

方法

收集北京协和医院收治的进展期直肠癌(T3期)患者62例,在新辅助放化疗前后,分别行常规直肠腔内超声(ERUS)和直肠腔内弹性成像检查。计算放化疗前后病灶SR差值及SR降幅,以SR降幅判断T分期降期。比较常规ERUS与弹性成像判断T分期降期的准确性。

结果

放化疗后,58例(58/62,94%)直肠癌病灶的SR值呈明显下降(t=2.823,P<0.01),另有4例(7%)SR值升高。pT0~2期的SR平均值为2.20±0.85,pT3期的SR平均值为3.19±0.90,两者差异具有统计学意义(t=3.684,P<0.01)。以SR降幅≥33.80%判断放化疗后T分期降期的准确性为69%(40/58),高于常规ERUS的准确性45%(28/62),但两者差异无统计学意义(P>0.05)。结合SR降幅,常规ERUS准确诊断降期由14例升高至28例,较好地提高了常规ERUS对T分期降期的诊断准确性。

结论

应用SR降幅可较好地辅助常规ERUS,提高直肠癌放化疗后T分期降期诊断准确性,为直肠癌新辅助放化疗疗效及预后评估提供一种新型的较为可靠、无创而又简便的影像学方法。

Objective

To evaluate the value of endorectal elastography with strain ratio measurements for predicting the downstage of T stage in locally advanced rectal cancer after neoadjuvant radiochemotherapy.

Methods

62 patients receiving neoadjuvant therapy had twice examinations of conventional endorectal ultrasound (ERUS) and endorectal elastography before radiochemotherapy and surgery. The difference and decreasing amplitude of SR were calculated , the downstage of T stage was predicted by decreasing amplitude of SR. The accuracy of conventional ERUS and endorectal elastography predicting the downstage were compared.

Results

58 patients (94%) demonstrated a significant decrease in strain ratios (t=2.823, P<0.01), and 4 patients (6.5%) demonstrated a increase in strain ration. The strain ratios of pT3 rectal cancer were significantly higher than that of pT0-2 rectal cancer (3.19±0.90 vs 2.20±0.85, t=3.684, P<0.01). When the cut-off point of the decreasing amplitude of SR≥33.80%, the accuracy of diagnosis of the downstage of pT stage after chemoradiotherapy by endorectal elastography was 69% (40/58), which is higher than that of the conventional ERUS (45.1%, 28/62), but the difference was not statistically significant (P<0.05). The conventional ERUS can correctly diagnosis 28 cases of the downstage increasing from 14 cases with the decreasing amplitude of SR.

Conclusions

The endorectal elastography with the decreasing amplitude of SR can assist the conventional ERUS, improve the diagnostic accuracy of the downstage of T stage in the rectal cancer after chemoradiotherapy, thereby providing a new reliable, noninvasive and convenient imaging methods for the assessment of the efficacy and prognosis of the rectal cancer after neoadjuvant chemoradiotherapy.

图1 弹性成像示直肠癌病灶内部颜色为蓝色,正常肠壁为红绿色,在常规ERUS图像上勾画腺瘤病灶区域(A),正常肠壁组织区域(B),获得应变比值为5.98
表1 常规ERUS与病理判断直肠癌病灶T分期降期比较
表2 病理降期与未降期直肠癌病灶的SR差值及SR降幅
图2 以直肠癌弹性应变比值降幅构建ROC曲线,获得曲线下面积为0.737
表3 不同SR降幅诊断直肠癌病灶的敏感度、特异度、准确性
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