对比增强MRI提高Tis-T1期直肠癌诊断准确性：与直肠腔内超声的头对头比较
该研究纳入136例病理确诊Tis-T2期直肠癌患者（138个病灶），评估对比增强MRI特征（黏膜下强化带）联合T2WI特征（肿瘤形态、固有肌层状态）构建的联合模型对Tis-T1期病灶的诊断效能，并与直肠腔内超声（ERUS）比较。结果显示联合模型AUC为0.915，显著优于ERUS的0.806（P=0.003），表明加入对比增强序列可提高MRI对早期直肠癌的分期准确性。
要点
- 对比增强MRI的黏膜下强化带（SES）是鉴别Tis-T1与T2期直肠癌的关键影像特征。
- 联合肿瘤形态、固有肌层状态和SES的MRI模型诊断效能最佳，AUC达0.915。
- 联合模型优于ERUS（AUC 0.806），为个体化保留器官治疗提供更可靠依据。
关键影像表现/征象
- 肿瘤形态和固有肌层状态在T2加权图像上评估，黏膜下强化带在对比增强MRI上评估。
- 联合模型整合了肿瘤形态、固有肌层状态和黏膜下强化带三个特征。
诊断标准与关键数值
- 固有肌层状态诊断Tis-T1期的AUC为0.762（95%CI：0.682-0.830）。
- 黏膜下强化带诊断Tis-T1期的AUC为0.861（95%CI：0.792-0.914）。
- 联合模型诊断Tis-T1期的AUC为0.915（95%CI：0.856-0.956）。
- ERUS诊断Tis-T1期的AUC为0.806（95%CI：0.730-0.868）。
- 联合模型与固有肌层状态比较，AUC差异=0.154，P<0.001；联合模型与ERUS比较，AUC差异=0.109，P=0.003。
临床应用与阅片要点
- 阅片时应结合T2WI评估肿瘤形态和固有肌层状态，并在对比增强MRI上重点观察黏膜下强化带。
- 联合模型有助于更可靠地识别Tis-T1期病灶，为个体化保留器官治疗规划提供依据。
- 与ERUS相比，对比增强MRI联合模型诊断效能更高，可作为术前分期的补充或替代参考。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
英文原文（摘要）· 点击展开
OBJECTIVE: To investigate whether the addition of contrast-enhanced sequences improves the diagnostic value of MRI in Tis-T1 rectal cancer and to compare its diagnostic performance with that of endorectal ultrasound (ERUS).
MATERIALS AND METHODS: Patients with pathologically confirmed Tis-T2 rectal cancer who underwent curative resection between January 2020 and December 2023 were enrolled. All patients underwent preoperative MRI (including contrast-enhanced sequencing) and ERUS. Tumor shape and the status of muscularis propria (SMP) were evaluated on T2-weighted images by a radiologist, whereas submucosal enhancing stripe (SES) was assessed on contrast-enhanced MRI. An MRI-based combined model was constructed by integrating tumor shape, SMP, and SES features. ERUS-based tumor staging was performed by an endoscopist. The diagnostic performance of SMP, SES, the combined model, and ERUS in identifying stage Tis-T1 lesions was evaluated. The area under the receiver operating characteristic curves (AUCs) was calculated, and statistical differences were assessed using the DeLong method.
RESULTS: In total, 136 patients (mean age: 60 ± 10 years; 78 men) with 138 lesions (82 Tis-T1 and 56 T2 lesions) were enrolled. The AUC values for SMP, SES, the combined model, and ERUS were 0.762 (95% confidence interval [CI]: 0.682-0.830), 0.861 (95% CI: 0.792-0.914), 0.915 (95% CI: 0.856-0.956), and 0.806 (95% CI: 0.730-0.868), respectively. Adding contrast-enhanced MRI feature significantly improved the diagnostic performance over the common approach (combined model vs SMP: AUC difference = 0.154; p < 0.001), and the combined model was also better than ERUS (AUC difference = 0.109; p = 0.003).
CONCLUSION: Incorporating contrast-enhanced MRI improves stage Tis-T1 rectal cancer diagnostic accuracy and outperforms ERUS.
KEY POINTS: Question Can adding contrast-enhanced MRI feature improve the diagnostic performance of MRI in identifying stage Tis-T1 rectal cancer compared to ERUS? Findings The MRI-based combined model incorporating contrast-enhanced and T2WI features achieved the best diagnostic performance (AUC value: 0.915), significantly superior to that of ERUS (p = 0.003). Clinical relevance Incorporating contrast-enhanced MRI offers a more reliable basis for personalized organ-sparing treatment planning and provides a foundation for future clinical practice guidelines.
引用
- Wan L, Li D, Kong Y, et al. Contrast-enhanced MRI improves diagnostic accuracy in stage Tis-T1 rectal cancer: a head-to-head comparison with endorectal ultrasound. Eur Radiol. 2026. PMID: 42047803. doi:10.1007/s00330-026-12565-w
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。