影像定量分析预测直肠癌淋巴结转移的价值  

Predictive value of quantitative image analysis for lymph node metastasis in patients with rectal cancer

作　　者：蒯玉娴 葛继元 王振[3] 杨剑 左长京 Kuai Yuxian;Ge Jiyuan;Wang Zhen;Yang Jian;Zuo Changfing(CT Room, the First People＇s Hospital of Yancheng, Yancheng 224006, China （ Kuai YX;Department of Nuclear Medicine, Changhai Hospital of Shanghai, Shanghai 200433, China （ Ge JY, Yang J, Zuo C J;Department of Radiology, Changhai Hospital of Shanghai, Shanghai 200433, China （Wang Z)

机构地区：[1]盐城市第一人民医院CT室,224006 [2]上海长海医院核医学科,200433 [3]上海长海医院放射科,200433

出　　处：《中华核医学与分子影像杂志》2018年第6期390-394,共5页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的探讨^18F-脱氧葡萄糖（FDG） PET/CT和MRI定量分析参数在直肠癌淋巴结转移预测中的价值。方法选取2013年5月至2015年10月间上海长海医院的直肠癌患者80例（男63例、女17例，年龄37～85岁），所有患者均于术前行MRI-弥散加权成像（DWI）及^18F-FDG PET/CT检查，且均有术后病理结果。采用多阈值自动分割法测量原发病灶^18F-FDG PET/CT代谢参数，采用总体勾画法测量表观弥散系数（ADC）值。分别以最大标准摄取值（SUVmax）＝2.5、20%SUVmax、30%SUVmax、40%SUVmax、50%SUVmax为阈值（依次为阈值1～5），由系统勾画感兴趣区（ROI）并计算相对应的平均标准摄取值（SUVmean）1～SUVmean5、代谢体积（MTV）1～MTV5和病灶糖酵解总量（TLG）1～TLG5。使用χ^2检验及多因素logistic回归分析直肠癌淋巴结转移同患者临床病理特征、18F-FDG PET/CT代谢参数及ADC值的相关性。 结果80例患者中，44例（55%）发生淋巴结转移。有淋巴结转移组原发病灶^18F-FDG PET/CT代谢参数均大于无淋巴结转移组，差异有统计学意义（u值：152.0～555.0，均P〈0.05）；有淋巴结转移组原发病灶ADC值[0.96（0.93，1.02）×10^－3 mm^2/s]小于无淋巴结转移组[1.07（1.01，1.11）×10^－3 mm^2/s]，差异有统计学意义（u＝249.0，P〈0.05）。单因素分析显示T分期、SUVmax、SUVmean1～SUVmean5、MTV1～MTV5、TLG1～TLG5、ADC值同直肠癌淋巴结转移有相关性（χ^2值：7.730～48.198，均P〈0.05）；多因素分析示，仅MTV1[比值比（OR）＝0.110，95% CI：0.014～0.840]、MTV2（OR＝0.075，95% CI：0.007～0.852）及ADC值（OR＝0.034，95% CI：0.003～0.381）为淋巴结转移的危险因素（均P〈0.05），其预测淋巴结转移的最佳阈值分别为：20.26 cm^3、18.47 cm^3和1.00×10^－3 mm^2/s。 结论由18F-FDG PET/CT测得的体积代谢参数MTV1、MTV2及MRI-DWI测得的ADC值为直肠癌淋巴结转移的危险因素，对直肠癌ObjectiveTo evaluate the values of the quantitative parameters obtained from ^18F-fluorodeoxyglucose （FDG） PET/CT imaging and MRI in prediction of lymph node metastasis （LNM） in patients with rectal cancer.MethodsFrom May 2013 to October 2015, 80 patients with rectal cancer （63 males, 17 females, age range： 37-85 years） that underwent preoperative MRI-diffusion weighted imaging （DWI） and ^18F-FDG PET/CT were enrolled. All patients had pathological results. Auto-segmentation methods of various thresholds were selected to determine the FDG metabolic parameters and whole volume region of interest （ROI） method was performed to measure apparent diffusion coefficient （ADC） in lymph node. Maximum standardized uptake value （SUVmax）=2.5, 20%SUVmax, 30%SUVmax, 40%SUVmax and 50%SUVmax were selected as the cut-off values （COV）, and named as COV1, COV2, COV3, COV4 and COV5, respectively. ROI was drawn automatically and the corresponding mean standardized uptake value （SUVmean）1-SUVmean5, metabolic tumor volume （MTV）1-MTV5 and total lesion glycolysis （TLG）1-TLG5 were calculated. χ^2 test and logistic regression analysis were used to analyze the associations between the LNM and pathological factors, as well as ^18F-FDG metabolic parameters and ADC.ResultsLNM was found in 55% （44/80） of the patients. The metabolic parameters of primary tumor in patients with LNM were significantly higher than those in patients without LNM （u values： 152.0-555.0, all P〈0.05）; the ADC was significantly lower in LNM positive cases than that in LNM negative cases： 0.96（0.93, 1.02）×10^-3 mm^2/s vs 1.07（1.01, 1.11）×10^-3 mm^2/s, u=249.0, P〈0.05. Univariate analysis showed that T stage, SUVmax, SUVmean1-SUVmean5, MTV1-MTV5, TLG1-TLG5, ADC value were associated with pathologic lymph node involvement （χ^2 values： 7.730-48.198, all P〈0.05）. Multivariate analysis indicated that MTV1 （odds ratio （OR）=0.110, 95% CI： 0.014-0.840）, MTV2 （OR=0.075, 95% CI： 0.007-0.85

关 键 词：直肠肿瘤 肿瘤转移 淋巴结 正电子发射断层显像术 体层摄影术 X线计算机 磁共振成像 脱氧葡萄糖 

分 类 号：R730.44[医药卫生—肿瘤] R735.37[医药卫生—临床医学]