高分辨率MRT2WI联合DWI评价直肠癌新辅助治疗后病理学完全缓解  

High resolution MR T2WI combined with DWI in evaluation of pathological complete response after neoadjuvant therapy in rectal cancer

作　　者：张晓燕[1] 李晓婷[1] 史燕杰[1] 王之龙[1] 刘玉良[1] 朱海滨[1] 孙应实[1] 

机构地区：[1]北京大学肿瘤医院医学影像科,北京市肿瘤防治研究所恶性肿瘤发病机制及转化研究教育部重点实验室,北京100142

出　　处：《中国介入影像与治疗学》2017年第3期164-168,共5页Chinese Journal of Interventional Imaging and Therapy

基　　金：国家自然科学基金青年项目(81501621)

摘　　要：目的探讨高分辨率MR T2WI联合DWI预测直肠癌新辅助治疗后病理学完全缓解的效能。方法回顾分析经完整新辅助治疗后接受根治性手术、新辅助治疗前后有完整2次MR影像资料、有明确病理学评价的进展期直肠癌患者364例,计算并比较单独使用高分辨率T2WI、高分辨率MR T2WI联合DWI预测直肠癌病理学完全缓解的效能。结果最终49例患者经病理证实为肿瘤完全缓解。单独使用高分辨率T2WI判断直肠癌是否病理学完全缓解的准确率为82.69%(301/364)、敏感度为40.82%(20/49)、特异度89.21%(281/315)、阳性预测值为37.04%(20/54)、阴性预测值为90.65%(281/310);高分辨率T2WI联合DWI预测直肠癌病理学完全缓解的准确率为87.36%(318/364)、敏感度为65.31%(32/49)、特异度为90.79%(286/315)、阳性预测值为52.46%(32/61)、阴性预测值为94.39%(286/303)。两种方法的敏感度差异有统计学意义(χ~2=4.96,P=0.03)。结论与单独使用高分辨率T2WI比较,高分辨率T2WI联合DWI评价直肠癌新辅助治疗后病理学完全缓解可提高诊断效能。Objective To evaluate the efficacy of high resolution MR T2WI combined with DWI in evaluation of pathological complete response after neoadjuvant therapy in rectal cancer. Methods Totally 364 patients with locally advanced rectal cancer who recieved neoadjuvant therapy and radical surgery, underwent MR scanning before and after neoadjuvant therapy, were enrolled in this study. The diagnostic efficacy of high resolution MR T2WI and high resolution MR T2WI combined with DWI in evaluation on pathological complete response after neoadjuvant therapy in rectal cancer were compared. Results Finally 49 cases were demonstrated pathologic complete response. Accuracy, sensitivity, specificity, positive predictive value and negative predictive value of high resolution MR T2WI and high resolution MR T2WI combined with DWI in predicting on pathological complete response after neoadjuvant therapy were 82.69% （301/364）, 40.82% （20/49）, 89.21% （281/315）, 37.04% （20/54）, 90.65% （281/310）and 87.36% （318/364）, 65.31% （32/49）, 90.79% （286/315）, 52.46% （32/61）, 94.39% （286/303）, respectively. Sensitivity had statiatical significant difference between two methods （χ2=4.96, P=0.03）. Conclusion Compared with high-resolution T2WI, the combination of DWI and high-resolution T2WI can improve the diagnostic efficacy in evaluation of pathologic complete response of locally advanced rectal cancer.

关 键 词：扩散磁共振成像 直肠肿瘤 病理学 完全缓解 

分 类 号：R735.37[医药卫生—肿瘤] R445.2[医药卫生—临床医学]