Study Of Medical Imaging In Anatomic Structure Related To "TME" And Preoperative Evaluation For Rectal Cancer

Part one: Study of medical imaging in anatomic structure related to total rectum mesorectal excision.Objective To study medical imaging of anatomic structurerelated to total rectum mesorectal excision . Methods Therewere 161pelvic samples in this study( 99 CT and52 MR ). All of the results were recorded and the date were analyzed with SPSS10.0 sofrware. Results The mesorectum was not demonstratedin 3 samples because rectum were stuffed with egesta. The demonstration rate of mesorerectal fascia were 93.93% in CT and 92.30% in MR. There was no significantly statistic difference between CT and MR. Denonvilliers fascia and sideligamenta of rectum were not demonstrated. ConclusionMultiple spiral CT and high resolving power MR can demonstrate mesorectum and mesorectal fascia clearly but can not demonstrate self-existent Denonvilliers fascia . The side ligamenta which was disputed among anatomists was not demonstrated in all images. So the result supports the idea that there has not specific side ligamenta in pelvic. Part two: Evaluation of preoperative medical imaging in total mesorectal excision for rectal cancerObjective Use MSCT and high-resolution MR to evaluate the feasibility of total mesorectal excision for rectal cancer before operation. Methods 32 biopsy-proven rectal cancer patientsaccepted MSCT and high-resolution MR examination, including 25 CT and 11MR. All of the images were observed and analyzed carefully . The result was compared with the histopathologicalfindings. Results In 32 patients, status of involvement ofrectum mesorerectal fascia was correctly prognosticated in 30 patients, one patients was overstaged in CT and one patient was overstaged in CT and MR. There was no significantly statistic difference between CT and MR. The birm of anus and knub can be demonstrated clearly in sagittal view image of MR. So the curve distance between them can be measured accurately with disposal technique. Eight patients have been fond having intumescent lymph node outside mesorerectal fascia, six of them were biopsy-proven transferred. 27 patients have been fond having intumescent lymph node inside mesorerectal , but forteen of them were biopsy-proven not transferred butinflammatory. conclusion MSCT and high-resolution MR canbe used to assess status of involvement of rectummesorerectal fascia correctly, in order to estimate the feasibility of TME. The curve distance between anus and knub can be measured accurately with MR disposal technique in order to estimate the possibility of Sphincter-preserving surgery. MSCT and high-resolution MR can be used to assess involvement of lymph node outside mesorerectal fascia so as to estimate the necessity of cleaning out of the lymph node outside the circumferential resection margin.