直肠癌术后病理标本与术前MRI/CT定义肿瘤范围的对比研究

刘媛媛; 朱苏雨; 陈晓艳; 文露; 李金娇; 鲍绪杰; 周菊梅; 聂少麟

doi:10.3969/j.issn.1000-8179.2017.13.490

直肠癌术后病理标本与术前MRI/CT定义肿瘤范围的对比研究

doi: 10.3969/j.issn.1000-8179.2017.13.490

刘媛媛^{①, ②, ③,},
朱苏雨^{①, ③, ,},
陈晓艳^④,
文露^⑤,
李金娇^{①, ②, ③},
鲍绪杰^{①, ②, ③},
周菊梅^{①, ③},
聂少麟^⑥

①.
湖南省肿瘤医院，湘雅医学院附属肿瘤医院腹部/淋巴瘤放疗科（长沙市 410013）
②.
湖南省肿瘤医院，湘雅医学院附属肿瘤医院南华大学研究生院（长沙市 410013）
③.
湖南省肿瘤医院，湘雅医学院附属肿瘤医院生物靶区调强放疗研究室（长沙市 410013）
④.
湖南省肿瘤医院，湘雅医学院附属肿瘤医院病理科（长沙市 410013）
⑤.
湖南省肿瘤医院，湘雅医学院附属肿瘤医院放射科（长沙市 410013）
⑥.
湖南省肿瘤医院，湘雅医学院附属肿瘤医院结直肠外科（长沙市 410013）

基金项目:

新国家自然科学基金 61271382

湖南省卫计委课题 B2017102

详细信息

作者简介:
刘媛媛专业方向为直肠癌的临床治疗，肿瘤精准靶区勾画。E-mail：yuanyuaniu@qq.com

通讯作者:
朱苏雨; E-mail: zhusuyu@hnszlyy.com

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出版历程
- 收稿日期: 2016-12-30
- 修回日期: 2017-06-27
- 刊出日期: 2017-07-15

Comparison of rectal cancer tumor volume parameters measured by MRI sequences and CT with those by pathological specimen

LIU Yuanyuan^{①, ②, ③
,},
ZHU Suyu^{①, ③
, ,},
CHEN Xiaoyan^④,
WEN Lu^⑤,
LI Jinjiao^{①, ②, ③},
BAO Xujie^{①, ②, ③},
ZHOU Jumei^{①, ③},
NIE Shaolin^⑥

①.
Department of Radiation Oncology, Lymphoma and Abdominal Section, Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiang Ya School of Medicine, Central South University, Changsha 410013, China
②.
Graduate School, China University of South China, Hengyang 421001, China
③.
Biological Targeting Modulated Radiotherapy Research Laboratory, China, Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiang Ya School of Medicine, Central South University, Changsha 410013, China
④.
Pathology Department, Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiang Ya School of Medicine, Central South University, Changsha 410013, China
⑤.
Diagnostic Radiology Department, Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiang Ya School of Medicine, Central South University, Changsha 410013, China
⑥.
Intestinal Surgery Department, Hunan Cancer Hospital, the Affiliated Cancer Hospital of Xiang Ya School of Medicine, Central South University, Changsha 410013, China

Funds:

the National Natural Science Foundation of China 61271382

the Health and Family Planning Commission of Hunan Province B2017102

More Information

Corresponding author: Suyu ZHU; E-mail: zhusuyu@hnszlyy.com

摘要

摘要: 目的比较直肠癌术后病理标本与术前MRI（T1WI、T2WI、DWI）和/或CT显示的肿瘤范围的差异。方法：选取2016年3月至2016年5月间于湖南省肿瘤医院拟行全直肠系膜切除术（TME）的直肠癌患者22例，术前行盆腔MRI（T1WI、T2WI、DWI）和/或增强CT检查。分别测量肿瘤沿肠管纵轴长度、垂直肠管横轴位肿瘤最宽径和横轴位肿瘤实际面积，并与术后病理标本测量对应参数比较，评估各影像测量的精确性。结果病理长度（L_path-L）为（4.06±1.14）cm，L_T1-L、L_T2-L、L_DWI-L、L_CT-L分别为（3.91±1.51）、（4.62±1.41）、（3.39±1.05）、（3.94±1.23）cm，与L_path-L的相关系数分别为0.688、0.635、0.688、0.720（P < 0.05）；T2WI测量结果存在平均6 mm高估，T1WI、DWI、CT测量结果存在1~6 mm不同程度的低估。病理横截面肿瘤最宽径（L_path-W）为（2.56±0.94）cm，L_T1-W、L_T2-W、L_DWI-W、L_CT-W分别为（3.62±0.99）、（3.66±0.76）、（3.23±0.58）、（3.64±1.04）cm，测量结果存在平均5.1~11.1 mm的高估。肿瘤病理实际面积（A_path）为（4.30±2.83）cm²，A_T1、A_T2、A_DWI、A_CT分别为（8.98±3.90）、（8.99±3.43）、（8.41±3.09）、（9.63±4.40）cm²，各影像测量实际面积存在约2倍程度高估。结论：在病变长度方面，各影像存在-6~6 mm差异；最大横截面方面均存在不同程度高估。因此在直肠癌放疗GTV勾画时，断面侧方应适当保守内收，而上下端也不应过多延伸。
- 直肠癌 /
- 病理标本 /
- 磁共振影像 /
- 计算机断层影像 /
- 大体肿瘤体积
Abstract: Objective This study aimed to compare rectal cancer tumor volume parameters measured by MRI sequences (T1WI, T2WI, and DWI) and/or CT with those by pathological specimen. Methods Twenty-two patients with rectal cancer were prospectively enrolled. MRI sequences including T1WI, T2WI, and DWI, and/or CT of the pelvis were performed before operation. Volume parameters, such as tumor length along the rectal axis, maximum tumor width perpendicular to rectal axis, and tumor actual area in that perpendicular plane, were measured on T1WI, T2WI, DWI, and CT, respectively, for each patient. The respective pathological parameters were further measured in surgical specimen after total mesorectal excision. The two kinds of parameter values measured in imaging and pathology were statistically compared and accuracy appraisal was performed. Results The mean L_path-L was 4.06±.14 cm. The mean L_T1-L, L_T2-L, L_DWI-L, and L_CT-L were 3.91±1.51, 4.62±.41, 3.39±.05, and 3.94±.23 cm, respectively. Correlation coefficients were 0.688, 0.635, 0.688, and 0.720 (P < 0.05). An average 6 mm overestimation was found in T2WI, and 1 to 6 mm underestimation in T1WI, DWI, and CT in length values compared with those measured in surgical specimen. The mean L_path-W was 2.56 ±.94 cm. The mean L_T1-W, L_T2-W, L_DWI-W, and L_CT-W were 3.62±.99, 3.66±.76, 3.23±.58, and 3.64±.04 cm, respectively. The magnitude of mean overestimation ranged from 5.1 to 11.1 mm. The A_path was 4.30 ±.83 cm². A_T1, A_T2, A_DWI, and A_CT were 8.98±.90, 8.99±.43, 8.41±.09, and 9.63±.40 cm², respectively, which double overestimated the tumor area in the perpendicular rectal plane. Conclusion The difference in longitudinal length between MRI sequences/CT and pathological specimen was in the range of -6 mm to 6 mm. The mean maximum tumor width and areas in the maximum tumor perpendicular plane were overestimated. This study indicated that gross tumor volume delineation based on CT or MRI for rectal cancer irradiation should be conservative in the axial images of rectum, and meticulous consideration is required along the rectum.
- rectal cancer /
- pathological specimen /
- MRI /
- computer-assisted tomography /
- gross tumor volume delineation

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图 1 直肠癌患者不同影像大体肿瘤体积（GTV）勾画

Figure 1. Example of the gross tumor volume (GTV) delineation in a rectal cancer patient

A. Sagittal T2WI; B. CT; C. Axial T2WI; D. DWI; E. LAVA-T1WI. Of the same patient, the tumor contour presented in red

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图 2 直肠癌病理标本的处理和肿瘤体积参数测量

Figure 2. Processing of pathological specimen and measurement of tumor volume parameters for rectal cancer

A. Measurement of the gross tumor length immediately after total mesorectum excision; B. Slicing across the widest tumor region with 5 mm thickness perpendicular to the rectum axis, recovering the specimen slice to its original form on the hollow board and fixing onto it with pins; C. Formalin specimen fixation for 24 hours; D. The slice was made into slides and stained with hematoxylin and eosin, and the tumor-containing boundary was macroscopically outlined with microscope

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图 3 不同影像测量与病理测量最大横截面肿瘤最宽径的Bland-Altman一致性分析

Figure 3. Bland-Altman plots showing the difference against mean maximum tumor width perpendicular to rectal axis measured on three imaging modalities and pathological parameters

A. T1WI; B. T2WI; C. DWI; D. CT. Dashed lines represent the 95% confidence intervals around the mean of difference. The solid lines represent the mean of difference

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表 1 22例直肠癌患者不同影像测量的大体肿瘤体积长度与术后标本病变长度的Pearson相关分析

Table 1. Correlation between rectal tumor length measured by MRI sequences (T1WI, T2WI, DWI), CT, and by pathological specimen

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