Value of dynamic enhanced magnetic resonance imaging in evaluating the efficacy and prognosis of middle and advanced low rectal cancer after concurrent chemoradiotherapy

doi:10.3877/cma.j.issn.1674-3946.2025.01.027.

Abstract

Abstract:

Objective

To investigate the value of dynamic enhanced magnetic resonance imaging（DCE-MRI） in evaluating the efficacy and prognosis of middle and advanced low rectal cancer after concurrent chemoradiotherapy.

Methods

A total of 112 patients with concurrent chemoradiotherapy for middle and advanced low rectal cancer treated from January 2019 to January 2022 were selected and divided into stable group （n=53 cases， stable lesion） and progressive group （n=59 cases， progressive lesion） according to the evaluation criteria of solid tumor efficacy.All patients were examined by DCE-MRI.DCE-MRI parameters （volume transfer yield （Ktrans）， rate constant （Kep）， extracellular space volume fraction （Ve）） were compared between the two groups before and after simultaneous chemoradiotherapy.SPSS 22.0 was used to process the data.Tumor morphological indexes and DCE-MRI parameters were expressed as （x ± s）， and independent sample t test was used for comparison between groups.The composition ratio was calculated by counting data such as recurrence rate and Chi-Square test was used.Kappa test was used for consistency analysis.P＜0.05 was considered statistically significant.

Results

Compared with before chemoradiotherapy， the length of rectal cancer tumor and the thickness of tumor intestinal wall were significantly decreased after chemoradiotherapy and 1 month after chemoradiotherapy （P＜0.05）， but there was no statistical significance between the two groups （P＞0.05）.There was no significant difference in the length and thickness of rectal cancer before chemoradiotherapy between the two groups （P＞0.05）.The length and thickness of rectal cancer after chemoradiotherapy and 1 month after chemoradiotherapy in the stable group were lower than those in the advanced group （P＜0.05）.Before chemoradiotherapy， Ktrans and Kep in stable group were higher than those in advanced group（P＜0.05）， but there was no statistical difference in Ve group （P＞0.05）.Ktrans， Kep and Ve were decreased after chemoradiotherapy in both groups compared with before chemoradiotherapy （P＜0.05）.After concurrent chemoradiotherapy， Ktrans and Kep in stable group were lower than those in advanced group （P＜0.05）， and there was no statistical significance in Ve group compared with advanced group （P＞0.05）.1 year follow-up， 112 patients with middle and advanced low rectal cancer， 6 cases lost follow-up， including 6 cases died； Among the other 100 patients with middle and advanced low rectal cancer， 16 cases recurred by pathological examination，with a recurrence rate of 16% （16/100）， and 14 cases recurred by DCE-MRI examination， with a recurrence rate of 14% （14/100）.Compared with the results of pathological examination， there was a good consistency between DCE-MRI and pathological examination （Kappa=0.813， P=0.000）.

Conclusion

DCE-MRI has important value in the prognosis assessment of concurrent chemoradiotherapy for middle and advanced low rectal cancer，and is worth popularizing.

Key words: Low Rectal Tumor, Dynamic Contrast-Enhanced Magnetic Resonance Imaging, Concurrent Chemoradiotherapy, Prognosis

Daiqin Li, Peijie Liu. Value of dynamic enhanced magnetic resonance imaging in evaluating the efficacy and prognosis of middle and advanced low rectal cancer after concurrent chemoradiotherapy[J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(01): 100-103.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhpwkssxzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-3946.2025.01.027.

https://zhpwkssxzz.cma-cmc.com.cn/EN/Y2025/V19/I01/100

Figures/Tables 4

组别	例数	性别（例）（男/女）	年龄（岁， $\overset{ˉ}{x}$ ±s）	临床分期（例）（T₃/T₄）
进展组	59	32/27	45.9±5.1	39/20
稳定组	53	30/23	46.3±5.2	38/15
t/χ²值		0.063	0.373	0.407
P值		0.801	0.710	0.523

组别	例数	性别（例）（男/女）	年龄（岁， $\overset{ˉ}{x}$ ±s）	临床分期（例）（T₃/T₄）
进展组	59	32/27	45.9±5.1	39/20
稳定组	53	30/23	46.3±5.2	38/15
t/χ²值		0.063	0.373	0.407
P值		0.801	0.710	0.523

组别	例数	时间	直肠癌肿瘤长度	肿瘤壁厚度
		放化疗前	6.9±1.4	2.6±0.4
进展组	59	放化疗后	6.0±1.9^a	1.9±0.2^a
		放化疗1个月后	5.9±1.8^a	1.8±0.2^a
		放化疗前	6.9±1.4	2.6±0.4
稳定组	53	放化疗后	5.0±1.8^ab	1.6±0.3^ab
		放化疗1个月后	4.9±1.6^ab	1.5±0.2^ab

组别	例数	时间	Ktrans（min）	Kep（min）	Ve
进展组	59	放化疗前	0.5±0.1	0.7±0.1	0.5±0.1
进展组	59	放化疗后	0.2±0.1^a	0.5±0.1^a	0.4±0.1^a
稳定组	53	放化疗前	0.5±0.2^b	0.9±0.2^b	0.5±0.1
稳定组	53	放化疗后	0.1±0.1^ab	0.2±0.1^ab	0.4±0.1^a

DCE-MRI	病理学检查		合计
DCE-MRI	非复发（n=70）	复发（n=30）	合计
非复发	50	20	70
复发	16	14	30

References 15

［1］	马翔，刘安文，邱建夫，等.不同腹腔镜经腹会阴联合切除术治疗低位直肠癌的近中期随访比较［J/CD］.中华普外科手术学杂志（电子版）， 2022， 16（01）: 48-51.
［2］	周振，沈浮，陆海迪，等.动态增强磁共振成像术前评估直肠癌肿瘤出芽等级的价值［J］.中国医学计算机成像杂志， 2022，28（04）: 379-384.
［3］	郭晓霖，薛良圆，田春梅，等.多模态磁共振成像在评估直肠癌术前分期、放化疗后再分期、放化疗疗效中的应用研究进展［J］.磁共振成像， 2023， 14（09）: 181-185.
［4］	肖建云，杨志勇，肖志锋.磁共振T2WI图像纹理分析在直肠癌T2/3分期中的应用价值［J］.中国医药导报， 2023， 20（16）:154-157.
［5］	孙静，陈阳，侯学文，等.基于多模态磁共振图像的直肠癌TN分期方法研究进展［J］.国际生物医学工程杂志， 2023， 46（01）:66-73.
［6］	王晨，徐青，余静，等.MRI影像组学评估直肠癌新辅助放化疗疗效［J］.实用放射学杂志， 2022， 38（5）: 759-763.
［7］	中华人民共和国国家卫生和计划生育委员会医政医管局，中华医学会肿瘤学分会.结直肠癌诊疗规范（2015年版［）J］.肿瘤综合治疗电子杂志， 2017， 3（01）: 19-19.
［8］	郑民华，马君俊，赵轩.中国腹腔镜直肠癌根治术式选择原则与规范化［J/CD］.中华普外科手术学杂志（电子版）， 2022，16（01）: 5-8.
［9］	王振，高星，王金勇.多层螺旋CT显像对结直肠癌术后再分期、区域淋巴结转移及疗效的评估价值［J］.实用癌症杂志，2022， 37（07）: 1125-1127， 1139.
［10］	王智清，陶芳旭，彭容，等.DCE-MRI预测进展期直肠癌新辅助放化疗效果中的应用价值［J］.中国CT和MRI杂志， 2020，18（01）: 137-139.
［11］	黄文，代欢欢，张文娟.DCE-MRI及IVIM在评估直肠癌患者胸苷酸合成酶表达水平中的价值［J］.临床放射学杂志， 2021，40（04）: 746-750.
［12］	陈照宏，尹建东，李晓晗，等.直肠癌血管生成参数及临床病理参数与动态增强磁共振血流灌注参数的相关性［J］.现代肿瘤医学， 2020， 28（16）: 2817-2821.
［13］	中华医学会放射学分会医学影像大数据与人工智能工作委员会，中国研究型医院学会医学影像与人工智能专业委员会，中国医师协会临床精准医疗专业委员会，等.影像组学多模态MRI量化分析用于直肠癌新辅助治疗后疗效及预后评估的方法学专家共识［J］.中华放射学杂志， 2022， 56（06）: 608-615.
［14］	张玉英，马骏，孙晓峰.基于磁共振T2加权图像的纹理分析评估直肠癌化疗后疗效的价值［J］.分子影像学杂志， 2023，46（02）: 307-310.
［15］	梁良，傅丽晖，王波，等.高分辨率磁共振成像辅助腹腔镜低位直肠癌手术的效果分析［J］.中国内镜杂志， 2022， 28（05）:20-26.

[1]	Xiaoyu Zhang, Yulai Yin, Yinxu Zhang. Efficacy and prognostic analysis of apatinib combined with neoadjuvant chemotherapy in triple negative breast cancer [J]. Chinese Journal of Breast Disease(Electronic Edition), 2024, 18(06): 346-352.
[2]	Jie Xu, Yajun Li, Junwei Han. Comparison of the efficacy of radical laparoscopic total gastrectomy in the treatment of overweight gastric cancer with two approaches [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(01): 19-22.
[3]	Jiehong Gao, Pingping Li, Jing Qi, Yinhai Dai. Study on the relationship between the expression of ETFA gene and clinicopathological parameters and prognosis in breast cancer [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2025, 19(01): 64-67.
[4]	Xiangyu Qu, Yigang Zhang, Haoling Li, Tian Qiu, Yi Tan. Diagnostic and prognostic role of USP24 and its co-expression of tumor metabolic genes in hepatocellular carcinoma [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(06): 659-662.
[5]	Wen Gu, Shouxin Ling, Haili Tang, Xuemei Gan. Comparison of two different surgical approaches for open radical surgery in patients with papillary thyroid cancer [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(06): 687-690.
[6]	Chengwang Fu, Dagang Yang, Rong Wang, Futang Li. Research progress of nutritional and inflammatory markers in resectable pancreatic cancer [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(06): 704-708.
[7]	Mengjie Liang, Huanhuan Zhu, Xingzhou Wang, Hang Jiang, Shichao Ai, Feng Sun, Peng Song, Meng Wang, Song Liu, Xuefeng Xia, Junfeng Du, Shuang Fu, Xiaofeng Lu, Xiaofei Shen, Wenxian Guan. Analysis of prognosis and postoperative complications of gastric cancer patients undergoing conversion therapy with combined immunotherapy [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(06): 619-623.
[8]	Zhizhao Zhang, Rui Wang, Pingping Gao, Chengfang Wang, Cheng Wang, Xiaowei Qi. Relationship between DNMT3B and prognosis of breast cancer and its biological mechanism [J]. Chinese Journal of Operative Procedures of General Surgery(Electronic Edition), 2024, 18(06): 624-629.
[9]	Wei Li, Zijian Song, Yancheng Lai, Rui Zhou, Han Wu, Longxin Deng, Rui Chen. The current state and prospects of artificial intelligence applied to prognosis prediction in prostate cancer patients [J]. Chinese Journal of Endourology(Electronic Edition), 2024, 18(06): 541-546.
[10]	Zun Chen, Ping Wang, Hua Jin, Meiling Zhou, Qingqing Li, Yonggang Huang. Application of sarcopenia in predicting incisional hernia after colorectal cancer surgery [J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2024, 18(06): 639-644.
[11]	Xiaoling Guan, Wenying Zhou, Hongping Chen. Predictive value of PTAAR for short-term prognosis of patients with hepatitis B virus-related acuteon-chronic liver failure [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(06): 841-845.
[12]	Runjin Zhang, Pan Yang, Yansi Lin, Zunlong Liu, Jianping Liu, Xiaoyan Jin. Epstein-Barr virus-associated cholangiocarcinoma complicated with multiple metastases: a case report and Chinese literature review [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(06): 865-869.
[13]	Xiaopeng Chen, Jiani Wang, Qinghai Lian, Jiumei Yang. Expression of VOPP1 in hepatocellular carcinoma and its relationship with prognosis [J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2024, 13(06): 876-882.
[14]	Jiagang Han, Zhenjun Wang. The treatment strategies for obstructive left-sided colon cancer [J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2024, 13(06): 450-458.
[15]	Zhaorong Guo, Xinguang Wang, Yiqiang Liu, Yingjian He, Lize Wang, Yang Yang, Xing Wang, Wei Cao, Chongshan Gu, Tie Fan, Jinfeng Li, Zhaoqing Fan. Clinicopathologic characteristics and prognostic risk factors of different subtypes of phyllodes tumor of the breast [J]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(06): 524-532.

Please choose a citation manager

Content to export