直肠癌原发灶PET/CT代谢参数和MRI-DWI预测区域淋巴结转移的研究  

Metabolic Parameters of PET/CT Combined with MR-DWI in Diagnosis of Regional Lymph Node Involvement in Rectal Cancer

作　　者：赵升[1] 田墨涵[1] 于丽娟[1] 袁林[1] 陈暮楠 

机构地区：[1]哈尔滨医科大学附属肿瘤医院,黑龙江哈尔滨150081

出　　处：《肿瘤学杂志》2017年第6期489-495,共7页Journal of Chinese Oncology

基　　金：黑龙江省自然科学基金(ZD2015017)

摘　　要：[目的]评价术前PET/CT代谢参数和MRI-DWI在预测直肠癌区域淋巴结(regional lymph node,rLN)转移中的价值。[方法 ]34例直肠癌患者术前进行前瞻性MRI和PET/CT联合研究,所有患者检查前未接受过针对肿瘤的治疗,先行直肠3.0T高分辨率MRI检查,随即进行全身PET/CT检查,两次检查连续序贯完成,检查后1周之内进行手术。在工作站上测量直肠癌原发灶的PET/CT代谢参数,包括平均标准化摄取值(mean standard uptake value,SUVmean)、最大标准化摄取值(maximum standard uptake value,SUVmax)、代谢体积(metabolic tumor volume,MTV)及总病灶糖酵解(total lesion glycolysis,TLG)以及MRI-DWI中的表观扩散系数(apparent diffusion coefficient,ADC)值;并分析rLN转移阴性组和阳性组代谢参数和ADC值的差异,应用ROC曲线分析各参数预测rLN转移的效能。[结果 ]rLN转移阳性组的MTVs、TLGs显著高于rLN转移阴性组,而ADCmean显著低于rLN转移阴性组(P均<0.05)。ROC曲线分析显示,MTV2.5、MTV3.0、MTV3.5、TLG2.5、TLG 3.0、TLG 3.5和ADCmean诊断直肠癌区域淋巴结转移的最佳截断点分别为33.69、23.12、20.95、187.97、166.31、73.77和0.86,各参数对直肠癌区域淋巴结转移的诊断效能差异无统计学意义。多因素分析显示TLG2.5是影响直肠癌区域淋巴结转移的独立危险因素。[结论 ]PET/CT代谢参数和MRDWI ADC值对直肠癌术前区域淋巴结良恶性的评估具有指导意义,TLG2.5可作为预测直肠癌区域淋巴结转移的重要危险因素。[Objective] To evaluate the metabolic parameters of preoperative PET/CT and MRIDWI in predicting the regional lymph nodes（rLN）involvement in rectal cancer. [Methods] Thirty-four rectal cancer patients without previous antineoplastic treatment were enrolled in the study.All patients received rectal 3.0T high resolution MRI and then whole body PET/CT,the surgery was performed a week after completion of the examinations. The PET/CT metabolic parameters and DWI parameters of primary rectal tumors were measured on the workstation,including the average standard uptake value（SUVmean）,the maximum standard uptake value（SUVmax）,metabolic tumor volume（MTV） and total lesion glycolysis（TLG） and apparent diffusion coeffecient（ADC）value.According to pathologic findings patients were divided into rLN negative group and rLN positive group. The differences of metabolic parameters and ADC values between the two groups were analyzed and the effect of various parameters on the prediction of r LN involvement was analyzed by using ROC curve. [Results] The rLN（＋） group showed significantly higher values of MTVs and TLGs,and lower values of ADCmean than rLN（-） group. ROC curve analysis showed that optimal cut-off to diagnosis r LN involvement of MTV2.5,MTV3.0,MTV3.5,TLG2.5,TLG 3.0,TLG 3.5and ADCmean were 33.69,23.12,20.95,187.97,166.31,73.77 and 166.31,respectively. KruskalWallis test showed that there were no differences in the diagnostic value of various parameters for rLN involvement. Multivariate analysis showed that TLG2.5 was an independent correlative factor to predict r LN involvement in rectal cancer. [Conclusion] PET/CT metabolic parameters and MRDWI ADC are of guiding value in differentiating benign or malignant of r LN in rectal cancer pre-operatively,and high TLG2.5 value is an independent risk factor to predict r LN involvement in rectal cancer.

关 键 词：直肠肿瘤 区域淋巴结转移 MTV TLG DWI ADC 

分 类 号：R735.31[医药卫生—肿瘤]