MRI联合实验室检查对直肠癌淋巴结转移的研究进展
Journal: Basic Medical Theory Research DOI: 10.12238/bmtr.v7i4.15514
Abstract
精准预判淋巴结转移是直肠癌患者治疗方案遴选与预后评估的核心环节。扩散加权成像(DWI)、体素内不相干运动(IVIM)、扩散峰度成像(DKI)、扩散张量成像(DTI)及动态增强MRI(DCE-MRI)等多元定量MRI技术,已逐步融入直肠癌淋巴结转移的预测体系。此外,实验室检查涵盖血清肿瘤标志物(如癌胚抗原CEA、糖链抗原19-9CA19-9、糖链抗原125CA125)及炎症标志物(如中性粒细胞与淋巴细胞比值NLR、血小板与淋巴细胞比值PLR、单核细胞与淋巴细胞比值MLR)等消化系统肿瘤的严重程度、诊疗效能及预后转归等具有相关性。本文通过综述上述影像技术、量化参数及实验室检测指标在区域淋巴结状态评估中的应用价值,旨在为临床诊疗实践提供可靠依据,并为后续研究探索提供参考方向。
Keywords
直肠癌；淋巴结转移；磁共振成像；实验室检查
Full Text
PDF - Viewed/Downloaded: 0 TimesReferences
[1] Sung H,Ferlay J,Siegel R L,et al.Global Cancer Statisti cs 2020: GLOBOCAN Estimates of Incidence and Mortality Worl dwide for 36 Cancers in 185 Countries[J].CA: A Cancer Journal for Clinicians,2021,71(3):209-249.DOI:10.3322/caac.21660.
[2] Kinugasa T,Akagi Y,Ochi T,et al.Lateral lymph-node diss ection for rectal cancer: meta-analysis of all 944 cases under going surgery during 1975-2004[J].Anticancer Res, 2013,33(7):2921-2927.DOI:null.
[3] Bates D D B,Homsi M E,Chang K J,et al.MRI for Rectal Can cer:Staging, mrCRM, EMVI, Lymph Node Staging and Post-Treat ment Response[J].Clinical Colorectal Cancer,2022,21(1):10-18.
[4] Brown G,Richards C J,Bourne M W,et al.Morphologic Predi ctors of Lymph Node Status in Rectal Cancer with Use of High -Spatial-Resolution MR Imaging with Histopathologic Compari son[J].Radiology,2003,227(2):371-377.
[5] Zhuang Z,Zhang Y,Wei M,et al.Magnetic Resonance Imagi ng Evaluation of the Accuracy of Various Lymph Node Staging Criteria in Rectal Cancer: A Systematic Review and Meta-An alysis[J].Frontiers in Oncology,2021,11(null):709070.
[6] Lehtonen T M,Ilvesmäki A,Koskenvuo L E,et al.The abili ty of magnetic resonance imaging to predict lymph node metas tases and the risk of recurrence in rectal cancer[J].J SURG ONCOL,2023,127(6):991-998.
[7] Beets N R A,Verheij F S,Williams H,et al.Association of Lateral Pelvic Lymph Nodes with Disease Recurrence and Organ Preservation in Patients with Distal Rectal Adenocarcinoma Treated with Total Neoadjuvant Therapy[J] Annals of Surgery,2025,282(2):311-318.
[8] 陈晓恺,翟钰瑄,毛涛,等.直肠高分辨MRI评估直肠癌术前T、N分期的价值分析[J].影像技术,2025,37(02):3-7.
[9] Deng S,Wu Z,Wu Y,et al.Meta-Analysis of the Correlation between Apparent Diffusion Coefficient and Standardized Uptake Value in Malignant Disease[J].Contrast Media & Molec ular Imaging,2017,2017(null):1-16.
[10] Kim S H,Ryu K H,Yoon J,et al.Apparent diffusion coeff icient for lymph node characterization after chemoradiation therapy for locally advanced rectal cancer[J].Acta Radiologi ca,2015,56(12):1446-1453.
[11] 刘晨,胡秀芝,陈韬.DWI、T2WI、ADC图多序列影像组学在直肠癌淋巴结转移预测中的应用分析[J].世界复合医学(中英文),2024,10(02):100-102.
[12] Pikūnienė I, Saladinskas, Basevičius A, et al. MRI Evaluation of Rectal Cancer Lymph Node Staging Using Appa rent Diffusion Coefficient[J].Cureus,2023,15(9):e45002.
[13] Qu W,Wang J,Hu X,et al.MRI radiomic study on predict ion of nonenlarged lymph node metastasis of rectal cancer: reduced field-of-view versus conventional DWI[J]. European Radiology Experimental, 2025,9(1):34.
[14] Šarošković M,Vuković M, Stojanoski S,et al. Signific ance of apparent diffusion coefficient in diagnosis of rectal carcinoma.[J].Front Oncol,2024,14(null):1464183.
[15] Yazdi S,Moradi S A,Rasoulighasemlouei S S,et al.Quant itative Dynamic Contrast-Enhanced Magnetic Resonance Imag ing and Positron Emission Tomography (PET) for Distinguishing Metastatic Lymph Nodes from Nonmetastatic Among Patients with Rectal Cancer:A Systematic Review and Meta-Analysis. [J].WORLD J NUCL MED,2025,24(1):3-12.
[16] Arian A, Taher H J,Suhail Najm Alareer H, et al. Value of Conventional MRI, DCE-MRI, and DWI-MRI in the Discrimin ation of Metastatic from Non-Metastatic Lymph Nodes in Rect al Cancer:A Systematic Review and Meta-Analysis Study[J].Asi an Pacific journal of cancer prevention:APJCP,2023,24(2):401-410.
[17] Xu Q,Xu Y,Wang J,et al.Distinguishing mesorectal tum or deposits from metastatic lymph nodes by using diffusion -weighted and dynamic contrast-enhanced magnetic resonance imaging in rectal cancer.[J].EUR RADIOL,2023,33(6):4127-4137.
[18] 胡接园,徐乙正,李建国,等.DCE-MRI与肿瘤标志物对直肠癌淋巴结转移的评估价值[J].中国CT和MRI杂志,2024,22(06):145-147.
[19] Granata V,Fusco R,Reginelli A, et al.Diffusion kurtosis imaging in patients with locally advanced rectal cancer:curre nt status and future perspectives[J].Journal of International Medical Research,2019,47(6):2351-2360.
[20] Li H,Yuan Y,Chen X L,et al.Value of intravoxel incohere nt motion for assessment of lymph node status and tumor response after chemoradiation therapy in locally advanced rec tal cancer[J].EUR J RADIOL,2022,146(null):110106.
[21] Long L,Zhang H,He X,et al.Value of intravoxel incohere nt motion magnetic resonance imaging for differentiating metastatic from nonmetastatic mesorectal lymph nodes with different short-axis diameters in rectal cancer.[J].J CANCER RES THER,2019,15(7):1508-1515.
[22] Zhao L,Liang M, Yang Y, et al. Histogram models based on intravoxel incoherent motion diffusion-weighted imaging to predict nodal staging of rectal cancer.[J]. EUR J RADIOL, 2021,142(null):109869.
[23] Yu J,Dai X,Zou H H,et al.Diffusion kurtosis imaging in identifying the malignancy of lymph nodes during the primary staging of rectal cancer.[J].COLORECTAL DIS, 2018,20(2):116- 125.
[24] McKeown E, Nelson D W,Johnson E K,et al.Current Appro aches and Challenges for Monitoring Treatment Response in Colon and Rectal Cancer[J]. Journal of Cancer, 2014,5(1):31-43.
[25] Maliborska S V,Holotiuk V V,Partykevich Y D,et al.DIAGN OSTICS OF LYMPHOGENIC METASTASIS IN PATIENTS WITH RECTAL CANCER BY COMBINING MRI WITH BLOOD CEA ASSESSMENT.[J].EXP ONCOL,2023,45(1):99-106.
[26] Xu M,Wang Z,Qiao X F,et al.A nomogram model for predic ting lymph node metastasis of rectal cancer by combining preoperative magnetic resonance imaging signs and tumour markers.[J].Pol J Radiol,2025,90(null):e114-e123.
[27] Zhong W,Yu Z,Zhan J,et al.Association of Serum Levels of CEA,CA199, CA125, CYFRA21-1 and CA72-4 and Disease Characteristics in Colorectal Cancer[J]. Pathology oncology research,2015,21(1):83-95.
[28] Yang X Q,Chen C,Wang F B,et al.Preoperative serum carcinoembryonic antigen,carbohydrate antigen19-9 and carb ohydrate antigen 125 as prognostic factors for recurrence -free survival in colorectal cancer[Z].2011:12,1251-1256.
[29] Hu B, Yang X,Xu Y,et al.Systemic Immune-Inflammation Index Predicts Prognosis of Patients after Curative Resection for Hepatocellular Carcinoma[J].Clinical Cancer Research,2014,20(23):6212-6222.
[30] Lin Y,You Z,Lin Z,et al.Association of clinicopathologi cal factor with lymph node metastasis in rectal cancer patie nts:a retrospective cohort study[J].BMC Gastroenterology,2025,25(1):358.
[31] El Asmar A,Delcourt M,Kamden L,et al.Prognostic Value of Preoperative Serological Biomarkers in Patients Undergoi ng Curative-Intent Cytoreductive Surgery for Colorectal Cancer Peritoneal Metastases[J].ANN SURG ONCOL,2023,30(3):1863-1869.
[32] Hamid H K S,Emile S H,Davis G N.Prognostic Significa nce of Lymphocyte-to-Monocyte and Platelet-to-Lymphocyte Ratio in Rectal Cancer: A Systematic Review, Meta-analysis, and Meta-regression[J].Diseases of the colon & rectum,2022,65(2):178.
[33] Zhang Y,Liu X,Xu M,et al.Prognostic value of pretreatm ent systemic inflammatory markers in patients with locally advanced rectal cancer following neoadjuvant chemoradiotherapy [J].Scientific Reports,2020,10(1):8017.
[34] Tao M,Wang Z,Zhang M,et al.Prognostic value of the sys tematic immune-inflammation index among patients with oper able colon cancer[J].Medicine,2018,97(45):e13156.
[2] Kinugasa T,Akagi Y,Ochi T,et al.Lateral lymph-node diss ection for rectal cancer: meta-analysis of all 944 cases under going surgery during 1975-2004[J].Anticancer Res, 2013,33(7):2921-2927.DOI:null.
[3] Bates D D B,Homsi M E,Chang K J,et al.MRI for Rectal Can cer:Staging, mrCRM, EMVI, Lymph Node Staging and Post-Treat ment Response[J].Clinical Colorectal Cancer,2022,21(1):10-18.
[4] Brown G,Richards C J,Bourne M W,et al.Morphologic Predi ctors of Lymph Node Status in Rectal Cancer with Use of High -Spatial-Resolution MR Imaging with Histopathologic Compari son[J].Radiology,2003,227(2):371-377.
[5] Zhuang Z,Zhang Y,Wei M,et al.Magnetic Resonance Imagi ng Evaluation of the Accuracy of Various Lymph Node Staging Criteria in Rectal Cancer: A Systematic Review and Meta-An alysis[J].Frontiers in Oncology,2021,11(null):709070.
[6] Lehtonen T M,Ilvesmäki A,Koskenvuo L E,et al.The abili ty of magnetic resonance imaging to predict lymph node metas tases and the risk of recurrence in rectal cancer[J].J SURG ONCOL,2023,127(6):991-998.
[7] Beets N R A,Verheij F S,Williams H,et al.Association of Lateral Pelvic Lymph Nodes with Disease Recurrence and Organ Preservation in Patients with Distal Rectal Adenocarcinoma Treated with Total Neoadjuvant Therapy[J] Annals of Surgery,2025,282(2):311-318.
[8] 陈晓恺,翟钰瑄,毛涛,等.直肠高分辨MRI评估直肠癌术前T、N分期的价值分析[J].影像技术,2025,37(02):3-7.
[9] Deng S,Wu Z,Wu Y,et al.Meta-Analysis of the Correlation between Apparent Diffusion Coefficient and Standardized Uptake Value in Malignant Disease[J].Contrast Media & Molec ular Imaging,2017,2017(null):1-16.
[10] Kim S H,Ryu K H,Yoon J,et al.Apparent diffusion coeff icient for lymph node characterization after chemoradiation therapy for locally advanced rectal cancer[J].Acta Radiologi ca,2015,56(12):1446-1453.
[11] 刘晨,胡秀芝,陈韬.DWI、T2WI、ADC图多序列影像组学在直肠癌淋巴结转移预测中的应用分析[J].世界复合医学(中英文),2024,10(02):100-102.
[12] Pikūnienė I, Saladinskas, Basevičius A, et al. MRI Evaluation of Rectal Cancer Lymph Node Staging Using Appa rent Diffusion Coefficient[J].Cureus,2023,15(9):e45002.
[13] Qu W,Wang J,Hu X,et al.MRI radiomic study on predict ion of nonenlarged lymph node metastasis of rectal cancer: reduced field-of-view versus conventional DWI[J]. European Radiology Experimental, 2025,9(1):34.
[14] Šarošković M,Vuković M, Stojanoski S,et al. Signific ance of apparent diffusion coefficient in diagnosis of rectal carcinoma.[J].Front Oncol,2024,14(null):1464183.
[15] Yazdi S,Moradi S A,Rasoulighasemlouei S S,et al.Quant itative Dynamic Contrast-Enhanced Magnetic Resonance Imag ing and Positron Emission Tomography (PET) for Distinguishing Metastatic Lymph Nodes from Nonmetastatic Among Patients with Rectal Cancer:A Systematic Review and Meta-Analysis. [J].WORLD J NUCL MED,2025,24(1):3-12.
[16] Arian A, Taher H J,Suhail Najm Alareer H, et al. Value of Conventional MRI, DCE-MRI, and DWI-MRI in the Discrimin ation of Metastatic from Non-Metastatic Lymph Nodes in Rect al Cancer:A Systematic Review and Meta-Analysis Study[J].Asi an Pacific journal of cancer prevention:APJCP,2023,24(2):401-410.
[17] Xu Q,Xu Y,Wang J,et al.Distinguishing mesorectal tum or deposits from metastatic lymph nodes by using diffusion -weighted and dynamic contrast-enhanced magnetic resonance imaging in rectal cancer.[J].EUR RADIOL,2023,33(6):4127-4137.
[18] 胡接园,徐乙正,李建国,等.DCE-MRI与肿瘤标志物对直肠癌淋巴结转移的评估价值[J].中国CT和MRI杂志,2024,22(06):145-147.
[19] Granata V,Fusco R,Reginelli A, et al.Diffusion kurtosis imaging in patients with locally advanced rectal cancer:curre nt status and future perspectives[J].Journal of International Medical Research,2019,47(6):2351-2360.
[20] Li H,Yuan Y,Chen X L,et al.Value of intravoxel incohere nt motion for assessment of lymph node status and tumor response after chemoradiation therapy in locally advanced rec tal cancer[J].EUR J RADIOL,2022,146(null):110106.
[21] Long L,Zhang H,He X,et al.Value of intravoxel incohere nt motion magnetic resonance imaging for differentiating metastatic from nonmetastatic mesorectal lymph nodes with different short-axis diameters in rectal cancer.[J].J CANCER RES THER,2019,15(7):1508-1515.
[22] Zhao L,Liang M, Yang Y, et al. Histogram models based on intravoxel incoherent motion diffusion-weighted imaging to predict nodal staging of rectal cancer.[J]. EUR J RADIOL, 2021,142(null):109869.
[23] Yu J,Dai X,Zou H H,et al.Diffusion kurtosis imaging in identifying the malignancy of lymph nodes during the primary staging of rectal cancer.[J].COLORECTAL DIS, 2018,20(2):116- 125.
[24] McKeown E, Nelson D W,Johnson E K,et al.Current Appro aches and Challenges for Monitoring Treatment Response in Colon and Rectal Cancer[J]. Journal of Cancer, 2014,5(1):31-43.
[25] Maliborska S V,Holotiuk V V,Partykevich Y D,et al.DIAGN OSTICS OF LYMPHOGENIC METASTASIS IN PATIENTS WITH RECTAL CANCER BY COMBINING MRI WITH BLOOD CEA ASSESSMENT.[J].EXP ONCOL,2023,45(1):99-106.
[26] Xu M,Wang Z,Qiao X F,et al.A nomogram model for predic ting lymph node metastasis of rectal cancer by combining preoperative magnetic resonance imaging signs and tumour markers.[J].Pol J Radiol,2025,90(null):e114-e123.
[27] Zhong W,Yu Z,Zhan J,et al.Association of Serum Levels of CEA,CA199, CA125, CYFRA21-1 and CA72-4 and Disease Characteristics in Colorectal Cancer[J]. Pathology oncology research,2015,21(1):83-95.
[28] Yang X Q,Chen C,Wang F B,et al.Preoperative serum carcinoembryonic antigen,carbohydrate antigen19-9 and carb ohydrate antigen 125 as prognostic factors for recurrence -free survival in colorectal cancer[Z].2011:12,1251-1256.
[29] Hu B, Yang X,Xu Y,et al.Systemic Immune-Inflammation Index Predicts Prognosis of Patients after Curative Resection for Hepatocellular Carcinoma[J].Clinical Cancer Research,2014,20(23):6212-6222.
[30] Lin Y,You Z,Lin Z,et al.Association of clinicopathologi cal factor with lymph node metastasis in rectal cancer patie nts:a retrospective cohort study[J].BMC Gastroenterology,2025,25(1):358.
[31] El Asmar A,Delcourt M,Kamden L,et al.Prognostic Value of Preoperative Serological Biomarkers in Patients Undergoi ng Curative-Intent Cytoreductive Surgery for Colorectal Cancer Peritoneal Metastases[J].ANN SURG ONCOL,2023,30(3):1863-1869.
[32] Hamid H K S,Emile S H,Davis G N.Prognostic Significa nce of Lymphocyte-to-Monocyte and Platelet-to-Lymphocyte Ratio in Rectal Cancer: A Systematic Review, Meta-analysis, and Meta-regression[J].Diseases of the colon & rectum,2022,65(2):178.
[33] Zhang Y,Liu X,Xu M,et al.Prognostic value of pretreatm ent systemic inflammatory markers in patients with locally advanced rectal cancer following neoadjuvant chemoradiotherapy [J].Scientific Reports,2020,10(1):8017.
[34] Tao M,Wang Z,Zhang M,et al.Prognostic value of the sys tematic immune-inflammation index among patients with oper able colon cancer[J].Medicine,2018,97(45):e13156.
Copyright © 2025 李岸霞
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License