高分辨力DWI-RESOLVE序列在直肠癌术前T分期中的价值  

The value of high resolution DWI-RESOLVE sequence in the preoperative T staging of rectal cancer

作　　者：马晓璐[1] 沈浮[1] 王振[1] 陈玉坤[1] 陆建平[1] 王敏杰[1] 

机构地区：[1]上海第二军医大学附属长海医院影像医学科,上海200433

出　　处：《放射学实践》2017年第9期947-950,共4页Radiologic Practice

摘　　要：目的:探讨高分辨力DWI-RESOLVE序列在直肠癌术前T分期中的价值。方法:回顾性分析经术后病理证实的40例直肠腺癌患者的病例资料,按照病灶是否突破固有肌层分为未突破组(A组)和突破组(B组),A组包括T1期和T2期,共17例,B组包括T3期和T4期,共23例。全部患者均行RESOLVE序列扫描(b值=0、1000s/mm^2)。两位医师独立分析图像并测量感兴趣区的ADC值;采用组内相关系数(ICC)分析两位医师测量结果的一致性。根据病理结果描绘受试者工作特性(ROC)曲线,计算曲线下面积、最佳诊断阈值、敏感度和特异度。结果:A组的平均ADC值为(1.230±0.160)×10^(-3) mm^2/s(医师1)和(1.200±0.166)×10^(-3) mm^2/s(医师2),高于B组的平均ADC值[(0.973±0.216)×10^(-3) mm^2/s(医师1)和(0.948±0.181)×10^(-3) mm^2/s(医师2)],两组间的ADC值差异有统计学意义(医师1:t=4.129,P<0.001;医师2:t=4.503,P<0.001)。两位医师ADC值测量结果的ICC为0.947。医师1的曲线下面积为0.820(95%CI:0.666~0.923),敏感度为60.87%,特异度为94.12%,诊断阈值为0.98×10^(-3) mm^2/s;医师2的曲线下面积为0.855(95%CI:0.708~0.946),敏感度为78.26%,特异度为76.47%,诊断阈值为1.07×10^(-3) mm^2/s。结论:高分辨力DWI-RESOLVE序列对于术前判断直肠癌是否突破固有肌层(T2期和T3期的鉴别)具有较高的参考价值。Objective：To study the value of high resolution DWI-RESOLVE sequence in the T staging of rectal cancer before surgery.Methods：The clinical materials of 40 patients with primary rectal cancer proved by pathology after surgery were analyzed retrospectively.They were divided into Group A（with intact muscularis propria,stage T1,T2;n=17）and Group B（with muscularis propria invasion,stage T3,T4;n=23）.All patients had MR DWI-RESOLVE（b=0,1000s/mm-2）performed.Two experienced radiologists analyzed the acquired images independently,and the apparent diffusion coefficient（ADC）of region of interest was measured.Intra-class correlation coefficient（ICC）was used to analyze the coincidence of the results measured by the two readers.The receiver operating characteristic（ROC）was drawn according to the pathology results,and the area under the curve（AUC）,the optimal diagnostic threshold,sensitivity,specificity were calculated.Results：The mean ADC value of Group A was（1.230±0.160）×10^-3 mm^2/s（reader #1）and（1.200±0.166）×10^-3 mm^2/s（reader#2）,respectively,which was higher than that of Group B,（0.973±0.216）×10^-3 mm^2/s（reader#1）and（0.948±0.181）×10^-3 mm^2/s（reader#2）,respectively,with significant statistic difference（reader# 1：t=4.129,P0.001;reader#2：t=4.503,P0.001）.The ICC between the two readers was 0.947.The AUC was 0.820（95% CI：0.666-0.923）,with the sensitivity and specificity as 60.87% and 94.12%,respectively and the diagnostic threshold as0.98×10^-3 mm^2/s for reader #1;the AUC was 0.855（95% CI：0.708-0.946）,with the sensitivity and specificity as78.26% and 76.47%,respectively,and the diagnostic threshold as 1.07×10^-3 mm^2/s for reader#2.Conclusions：High resolution DWI-RESOLVE sequence can improve the efficiency in the assessment of muscularis propria invasion（differentiation of T stage 2from T3）of rectal cancer before surgery.

关 键 词：直肠肿瘤 磁共振成像 扩散加权成像 表观扩散系数 肿瘤分期 

分 类 号：R445.2[医药卫生—影像医学与核医学] R735.37[医药卫生—诊断学]