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.

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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

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