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目的探讨磁共振成像对直肠癌患者术后局部复发的临床诊断效果。方法选取2015年5月至2017年5月间沈阳医学院附属中心医院收治的90例直肠癌术后局部复发的患者,均接受直肠癌根治术+常规化疗。采用磁共振成像(MRI)与电子计算机断层扫描(CT)进行诊断,比较两种方法诊断直肠癌患者术后局部复发的准确性、特异性及灵敏性。结果 MRI诊断直肠癌患者术后复发的准确性、灵敏性和特异性分别为91.1%、86.7%和73.3%,CT诊断分别为75.6%、66.7%和60.0%,MRI较CT诊断结果均较高,差异均有统计学意义(均P<0.05)。直肠癌患者术后局部复发的MRI征象为:骶前分叶状肿块,T1WI呈低信号,T2WI及弥散加权(DWI)呈高信号,增强扫描不均匀或环形强化。CT征象为:骶前出现密度分布不均的团组织肿块,增强扫描可见中心坏死、边缘高低不平的环状强化,吻合口出处不规则增厚,腔隙变窄,伴有盆腔组织受累。结论 MRI诊断直肠癌患者术后局部复发相比CT,具有较高的准确性及灵敏性,为术后复发的治疗可提供合理依据。
Objective To investigate the clinical diagnosis of postoperative local recurrence in patients with rectal cancer by magnetic resonance imaging. Methods Totally 90 patients with local recurrence after rectal cancer admitted to Central Hospital Affiliated to Shenyang Medical College from May 2015 to May 2017 were enrolled in this study. All patients underwent rectal cancer radical mastectomy plus conventional chemotherapy. Magnetic resonance imaging (MRI) and computed tomography (CT) were used to diagnose the accuracy, specificity and sensitivity of the two methods in the diagnosis of postoperative local recurrence in patients with rectal cancer. Results The accuracy, sensitivity and specificity of MRI in the diagnosis of rectal cancer patients were 91.1%, 86.7% and 73.3% respectively. The CT diagnosis was 75.6%, 66.7% and 60.0% respectively. The MRI findings were higher than those of CT , The differences were statistically significant (all P <0.05). The MRI findings of postoperative local recurrence in rectal cancer patients were lobular tumor of presacral area, low signal intensity on T1WI, high signal intensity on T2WI and DWI, enhanced scanning unevenness or annular enhancement. The signs of CT were as follows: there were irregular masses in the mass before the sacral mass, enhanced necrosis in the center, ring-shaped enhancement of rugged edges, anomalous thickening of the anastomosis, narrowing of the lacunar cavity and involvement of pelvic tissues. Conclusion MRI diagnosis of rectal cancer patients with local recurrence compared with CT, with high accuracy and sensitivity, and provide a reasonable basis for the treatment of postoperative recurrence.