SO SÁNH GIÁ TRỊ GIỮA CẮT LỚP VI TÍNH VÀ CỘNG HƯỞNG TỪ TRONG ĐÁNH GIÁ LẠI GIAI ĐOẠN T CỦA UNG THƯ BIỂU MÔ TRỰC TRÀNG SAU ĐIỀU TRỊ TÂN HỖ TRỢ=Comparison of the value between computed tomography and magnetic resonance imaging in reassessment of the T-stage of rectal cancer after neoadjuvant therapy

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Tác giả: Thanh Ngọc Lâm, Quang Hưng Ngô, Minh Hoàng Trần, Tấn Đức Võ

Ngôn ngữ: vie

Ký hiệu phân loại:

Thông tin xuất bản: Tạp chí Điện quang và Y học hạt nhân Việt Nam, 2024

Mô tả vật lý: tr.46-52

Bộ sưu tập: Metadata

ID: 486825

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Giới thiệu: Đánh giá giai đoạn đóng vai trò quan trọng để lựa chọn phương thức điều trị tối ưu cho người bệnh ung thư biểu mô trực tràng (UTTT). Đặc biệt đối với trường hợp sau hóa xạ tân hỗ trợ (HXTHT), việc này ảnh hưởng đến phương pháp phẫu thuật, ví dụ cắt trọn tại chỗ hay toàn bộ trực tràng.Mục tiêu: So sánh giá trị của cắt lớp vi tính (CLVT) và cộng hưởng từ (CHT) trong việc đánh giá giai đoạn u tại chỗ (yT), tình trạng di căn hạch vùng và diện cắt chu vi (yCRM) sau hóa xạ tân hỗ trợ (HXTHT).Đối tượng và phương pháp nghiên cứu: Nghiên cứu mô tả cắt ngang trên 62 bệnh nhân UTTT được chụp CLVT và CHT trước và sau HXTHT với liệu trình dài, có phẫu thuật và kết quả giải phẫu bệnh (GPB) tại Bệnh viện Đại học Y Dược thành phố Hồ Chí Minh. Giai đoạn bệnh được đánh giá lại trước phẫu thuật trên CLVT và CHT, đối chiếu với kết quả GPB có mô tả đầy đủ giai đoạn ypT, di căn hạch, ypCRM.Kết quả: Giá trị của CLVT và CHT đánh giá giai đoạn khác T0 là không khác biệt. Cả hai phương tiện chẩn đoán đều có độ nhạy, giá trị tiên đoán dương và độ chính xác cao trong đánh giá giai đoạn khác T0. CLVT và CHT đều có độ đặc hiệu, độ chính xác và giá trị tiên đoán âm cao trong đánh giá giai đoạn T4 (82 – 94,5%). Về độ chính xác chung, CLVT thấp hơn CHT trong đánh giá giai đoạn T (38,7 so với 54,8%). Trong đánh giá có hay không hạch di căn, CLVT và CHT không có sự khác biệt rõ về giá trị. Cả hai đều có giá trị tiên đoán âm khá tốt, xấp xỉ 80%. CLVT và CHT đều có giá trị tiên đoán âm cao trong đánh giá xâm lấn cân mạctreo trực tràng, xấp xỉ 95%. CHT có độ đặc hiệu, độ chính xác cao hơn CLVT từ 11-13%.Kết luận: Sau điều trị tân hỗ trợ, CLVT và CHT đều cho độ tin cậy tốt trong phát hiện mô u còn lại, do đó có thể cân nhắc chiến lược “theo dõi và chờ” đối với những trường hợp không còn thấy u. Cả hai đều cho độ tin cậy tốt để loại trừ giai đoạn yT4, di căn hạch vùng và xâm lấn cân mạc treo trực tràng (CMTTT).Introduction: Staging assessment plays an important role in choosing the optimal treatment method for patients with rectal cancer. Especially in the case of neoadjuvant chemoradiation, this affects the surgical method, for example local or total rectal resection.Purpose: Comparing the value of computed tomography and magnetic resonance imaging in predicting local tumor stage (yT), regional lymph node metastasis and Circumferential resection margin (yCRM) after neoadjuvant chemoradiation.Methods: Cross-sectional study on 62 rectal cancer patients who underwent CT and MRI before and after neoadjuvant chemoradiation with a long course, surgery and pathology results at Ho Chi Minh City University of Medicine and Pharmacy Hospital. The disease stage was reassessment before surgery on CT and MRI, compared with pathology results with a complete description of ypT stage, lymph node metastasis, and ypCRM.Results: The value of CT and MRI to evaluate non-T0 stages is not different. Both diagnostic tools have high sensitivity, positive predictive value, and accuracy in assessing non-T0 stages. CT and MRI both have high specificity, accuracy and negative predictive value in assessing stage T4 (82 - 94.5%). Regarding overall accuracy, CT is lower than MRI in assessing T stage (38.7 vs. 54.8%). In assessing lymph nodes metastasis, CT and MRI do not have a clear difference in value. Both have quite good negative predictive values, approximately 80%. CT and MRI both have high negative predictive value in assessing mesorectal fascia invasion, approximately 95% and MRI has 11-13% higher specificity and accuracy than CT. Conclusions: After neoadjuvant therapy, CT and MRI both show good reliability in detecting remaining tumor, so a "watch and wait" strategy can be considered for cases where the tumor is no longer visible. Both have good reliability to exclude stage yT4, regional lymph node metastasis and mesorectal fascia invasion.

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