Advances in imaging and pathological research on extramural vascular invasion of rectal cancer

壁外血管侵犯(EMVI)是指胃肠道肿瘤所在肠管固有肌层外的血管腔内出现肿瘤浸润.MRI检查发现直肠壁外血管管腔异常扩张,形态不规则,且其内流空信号为肿瘤组织信号所代替即可诊断EMVI.以病理学为金标准,对于血管直径＞3 mm的EMVI,高分辨MRI检查诊断EMVI的敏感度和特异度高达100％和89％.病理学及高分辨MRI检查所诊断的EMVI与直肠癌局部复发,远处转移以及肿瘤相关死亡具有显著相关性,并被证实为无瘤生存时间及总生存时间的独立性预测因子.EMVI作为直肠癌影像学危险度分层指标之一,被应用于筛选适合术前新辅助放化疗的高风险直肠癌.而且,高分辨率MRI检查诊断EMVI被证实为预测直肠癌新辅助放化疗效果的独立相关因素.类似于高分辨MRI检查肿瘤退缩分级,EMVI经新辅助放化疗后的变化同样可以应用肿瘤退缩分级方法进行评价.Extramural vascular invasion(EMVI)was defined as the presence of tumor cells within an endotheliumlined vessel beyond the muscularis propria.High-resolution MRI had 100％sensitivity and 89％specificity in identification of large(caliber greater than 3 mm)EMVI with histopathology as reference.EMVI detected by both histopathology and MRI was significantly associated with local recurrence,distance metastasis and tumor-related death in rectal cancer,which was also identified as an independent prognostic factor for 3-year tumor-free survival and overall survival.EMVI could be used as one of the risk factors,which would allow stratification of patients with rectal cancer to receive neoadjuvant chemoradiotherapy(neoCRT).Moreover,EMVI detected by high-resolution MRI was identified as an independent predictor for response to neoCRT.Tumor regression grading scale defined by high-resolution MRI could be used to evaluate EMVI regression after neoCRT.中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)8847-8501