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目的与直肠腺癌(adenocarcinoma,AC)相比,探讨原发性直肠印戒细胞癌(signet ring cell carcinoma,SRCC)的磁共振成像(magnetic resonance imaging,MRI)特征。材料与方法回顾性分析经病理证实的28例直肠印戒细胞癌及31例直肠腺癌(非印戒细胞癌、非黏液腺癌)患者的首诊直肠MR资料。比较其TNM分期、T2WI序列肿瘤信号以及肿瘤基本影像学特点。结果 28例直肠SRCC中,肿瘤纵径平均49.33 mm,突破直肠固有肌层平均4.03 mm,肿瘤下缘距肛缘平均58.44 mm。SRCC出现远处转移率25.0%(7/28),10.7%(3/28)出现腹膜转移。SRCC环周浸润>1/2周比率高于AC(92.9%vs 61.3%,P=0.004),T2WI序列SRCC肿瘤/脂肪、肿瘤/肌肉、肿瘤/尿液信号比均高于AC。两类组织学肿瘤的肠壁横向最大厚度、纵径最大累及范围及肿瘤下缘至肛缘距离差异均无统计学意义。在肿瘤突破直肠固有肌层外距离方面,AC高于SRCC(6.03 mm vs 4.03 mm,P=0.044)。结论与腺癌相比,直肠印戒细胞癌浸润肠壁常大于1/2周径,但突破肌层距离相对局限,其MR T2WI信号高于腺癌,因此MR征象可在一定程度上鉴别SRCC与AC,从而为直肠癌多学科诊疗团队提供影像依据。
Objective To investigate the magnetic resonance imaging (MRI) features of primary signet ring cell carcinoma (SRCC) in comparison with adenocarcinoma (AC). Materials and Methods Retrospective analysis of pathologically confirmed 28 cases of rectal signet-ring cell carcinoma and 31 cases of rectal adenocarcinoma (non-signet ring cell carcinoma, non-mucinous adenocarcinoma) patients first rectal MR data. Compare their TNM staging, T2WI tumor signal and tumor basic imaging features. Results In 28 cases of rectal SRCC, the average length of tumor was 49.33 mm, the average length of rectum was 4.03 mm, and the lower edge of tumor was 58.44 mm from the anal verge. The distant metastasis rate of SRCC was 25.0% (7/28), and peritoneal metastasis occurred in 10.7% (3/28). The ratios of perivascular infiltration> 1/2 week in SRCC were higher than that in AC (92.9% vs 61.3%, P = 0.004). The ratio of tumor / fat, tumor / muscle and tumor / urine in T2WI sequence was higher than that in AC. There was no significant difference in the maximal transverse thickness, the largest extent of longitudinal dimension and the distance between the lower edge of the tumor and the anal margin in both histological tumors. The AC was higher than that of SRCC (6.03 mm vs 4.03 mm, P = 0.044) in terms of tumor breakthrough beyond the rectus abdominis. Conclusion Compared with adenocarcinoma, rectal signet-ring cell carcinoma infiltration of the intestinal wall often larger than 1/2 weeks in diameter, but the break through the myometrial distance is relatively limited, its MR T2WI signal is higher than adenocarcinoma, so MR signs can be identified to some extent SRCC And AC, thus providing multi-disciplinary team for rectal cancer imaging basis.