3．0T磁共振在直肠癌术后复发与良性病变鉴别诊断中的应用  

Differentiation of recurrence rectal cancer and benign pelvic lesions after curative rectal operation with 3.0 T magnatic resonance

作　　者：王莉莉[1] 段青[1] 薛蕴箐[1] 黄新明[1] 王承胜[1] 孙斌[1] 

机构地区：[1]福建医科大学附属协和医院CT室,福州350001

出　　处：《中华胃肠外科杂志》2011年第11期859-863,共5页Chinese Journal of Gastrointestinal Surgery

摘　　要：目的评价3．0T MR的T2加权成像（T2WI）、弥散加权成像（DWI）和三维容积内插屏气检查（3D—VIBE）在直肠癌术后肿瘤复发与良性病变鉴别诊断中的应用价值。方法回顾性分析福建医科大学附属协和医院2007年4月至2010年10月经MR检出的28例直肠癌术后病变患者的MR影像资料．28例患者均接受T2WI序列和DWI序列检查，其中有24例接受3D—VIBE序列检查。选取13例同时期因盆腔其他病变行MR扫描而直肠无病变的病例为正常对照组。测量计算T2WI中病灶或正常直肠壁与右侧臀大肌的信号强度比值（SIL／SIM）、表观弥散系数（ADC）值、髂外动脉增强达高峰后第2个序列的病变信号强度净增值与髂外动脉信号强度净增值的比值（SIL／SIA），观察时间-信号强度曲线（TIC）形态，划分良性型（平坦型和持续强化型）与恶性型（迅速强化型）。以手术病理结果或临床综合诊断结果为最后诊断。结果28例患者中共检出不同性质的病灶29个，其中直肠癌复发病灶17个，良性病灶12个，包括纤维瘢痕组织4个（其中陈旧性脓肿1个），慢性炎性病灶6个，瘘管1个，脓肿1个；有14个病灶经手术病理证实。SIL／SIM在良性组为2．84±1．52．恶性组为2．58±0．80，正常对照组为2．13±0．58：3组间比较，差异无统计学意义（F=1．620，P=0．211）。以（1．21×10^-3）mm^2／s为阈值，ADC值诊断恶性病变的敏感性为100％（17／17），特异性为91．7％（11／12）．准确性为96．6％（28／29）（Kappa检验P=0．928），诊断一致性好；以0．28为阈值，SIL／SIA诊断的敏感性为100％（13／13），特异性为66．7％（8／12），准确性为84．0％（21／25）（Kappa检验P=0．675），诊断一致性中等：以TIC为诊断标准．诊断的敏感性为100％（13／13），特异性为83．3％（10／12），准确性为92．0％（23／25）。结论T2WI技术无法鉴别诊�Objective To evaluate the value of T2WI, DWI and 3D-VBIE at 3.0 T MR in the differentiation of recurrent rectal cancer and benign pelvic lesions after curative rectal operation. Methods A total of 28 patients with abnormal pelvic lesions confirmed by CT or MR from April 2007 to October 2010 were evaluated with MR imaging. All the patients received examinations of both T2WI and DWI, and 24 of them received additional examination of 3D-VIBE. Thirteen patients with MR imaging in the same period who were confirmed to have no diseases of the rectum were used as control group. The mean apparent diffusion coefficient（ADC） value and the ratio of the signal intensity（SI） of the lesions to the gluteus maximus in T2WI （SIL/SIM） and the ratio of the net added signal intensity of the lesions to the net added signal intensity of the iliac artery （SIL/SIA） at the time of 35 seconds after the iliac artery achieved its highest intensity were measured and calculated. The type of the time- intensity curve （TIC） was overviewed and classified as the benign type when the TIC was rising slowly or constantly and lasted for more than 90 s; however the malignant type when the TIC was rising significantly but lasted less than 90s kept as a horizontal line for a period or was descending slowly or rising slowly. Results There were 29 lesions of different final diagnosis, including 17 recurrence rectal cancers, 4 fibrous masses, 6 stoma inflammations, 1 sinus and 1 abscess. Fourteen of them were confirmed by pathological examination. The ratio of SIL/SIM was 2.84±1.52 in the benign group, 2.58±0.80 in the malignant group, and 2.13±0.58 in the control group, the differences between the 3 groups were not statistically significant （F=1.620, P=0.211）. When the ADC value of 1.21×10^-3 mm^2/s was set as a diagnostic threshold, the sensitivity, specificity, accuracy and coherence for the diagnosis of the malignant lesions were 100%（17/17）, 91.7%（11/12）, 96.6%（28/29） and 0.928, respectively. When the SIw/SIA va

关 键 词：直肠肿瘤 复发 磁共振成像 弥散 三维容积内插屏气检查 

分 类 号：R735.37[医药卫生—肿瘤]