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the Estimation of efficiency of a magnitno-resonant tomography in definition of an invasion of a tumour in mezhsfinkternoe space

In investigated group at 18 from 20 patients the invasion of a cancer of the proctal channel in mezhsfinkternoe space has been taped, in two cases diffusion of a tumour to a fat of an ischiorectal fossa, that took place

Meant infiltration as mezhsfinkternogo spaces, and an external sphincter.

mezhsfinkternoe the space on Т2-ВИ in an axial plane was defined as an annular stria of a hyperintensive tissue by thickness of 1-2 mm, located between internal and external sphincters, and its infiltration was defined as presence in it of a tissue similar under alarm characteristics with tumoral (the Drawing 22).

And

Drawing 22. An example of a cancer of the proctal channel without an invasion () and with an invasion () in mezhsfinkternoe space on Т2-ВИ in an axial plane. The finger on the image () notes a zone of an invasion of a tumour in mezhsfinkternoe space; the extremities of fingers - mezhsfinkternoe space; * - a tumour

In 38,9 % of cases the tumour, according to MRT, was localised within a mucosa or an internal sphincter, leaving mezhsfinkternoe space intact. To all these patients subsequently it has been spent sfinktersohranjajushchee operative treatment, however at the subsequent analysis of data of pathomorphologic research in one case from seven in resection edge tumoral cells that has entailed appointment adjuvantnoj himioluchevoj therapies have been found out. The repeated retrospective analysis Mr - images of a unique case of the false-negative conclusion has not taped signs of infiltration of space, possibly, at the expense of microscopical character of a tumoral invasion.

At 61,1 % of patients the tumour extended in mezhsfinkternoe space. False positive cases of diagnostics of infiltration mezhsfinkternogo spaces at comparison of data MRT with results of pathomorphologic research it has not been taped.

Following possibilities MRT in diagnostics of a tumoral invasion in mezhsfinkternoe space are established: sensitivity - 91,6 % [59,6; 99,6], specificity - 100 % [51,7; 100], positive and negative

Prognostic value - 100 % [67,9; 100] and 85,7 % [42,0; 99,2] accordingly.

Thus, technique MRT developed by us allows to reach good results in an estimation of local prevalence of malignant tumours of a rectum and the proctal channel. The method has the limited possibilities in discrimination of tumours Т1-and Т2-стадии, however is characterised by a high indicator of prognostic negative value (93,3 %) that means low risk of false positive results in an estimation of an invasion of a muscular layer of an intestinal wall.

In an estimation of an extramural invasion of tumour MRT shows high indicators of sensitivity and specificity (93,7 % and 87,3 %, accordingly) under condition of combined interpreting Т2-ВИ and DVI. The Most significant signs of an invasion of a tumour in a pararectal fat are presence in it of nodous changes or its fabric obliteration. As additional criteria of diffusion of a tumour for limits of an intestinal wall such indicators as its length and tsirkuljarnost, and also average value IKD can be used.

MRT allows to diagnose presence limfovenoznoj a tumoral invasion with sensitivity of 92,9 % and specificity of 100 %. Thus the most specific signs limfovenoznoj a tumoral invasion were presence of a tumoral tissue in a lumen of a vessel and an exit of a tumoral tissue for the limits of a vascular wall taped on Т2-ВИ and DVI. As the Accessory sign atypical expansion of calibre of a vessel can serve also.

As criteria of diffusion of a tumour on a visceral peritoneum on Т2-ВИ contact of a tumour to a peritoneum and an exudate can serve in an abdominal cavity in the field of the amazed site of an intestine.

Diagnostic indicators MRT in revealing of an invasion of a tumour in the next organs have appeared are high and have made: sensitivity - 93,8 %, specificity - 96,3 %. The most specific sign of an invasion was direct

Tumour diffusion on the next organ, and the most sensitive - a fat obliteration between a tumour and an interfacing organ. Deformation by a tumour of contours of an organ can testify only to volume influence of a neoplasm and is not an obligate sign infiltrativnogo tumoral growth.

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A source: PETROV Cyril Sergeevich. of POSSIBILITY VYSOKOPOLNOJ of the MAGNITNO-RESONANT TOMOGRAPHY In the ESTIMATION of LOCAL PREVALENCE And EFFICIENCY of TREATMENT of the CANCER of the RECTUM And the PROCTAL CHANNEL. The dissertation on competition of a scientific degree of the candidate of medical sciences. St.-Petersburg - 2014. 2014

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