磁共振成像扩散峰度成像在直肠癌组织学类型及病理分级中的应用  

Application of diffusion kurtosis imaging in distinguishing histologic types and pathological grading of rectal adenocarcinoma

作　　者：文自强 杨心悦[1] 陈琰 卢宝兰 肖晓娟[2] 庄晓曌[3] 余深平[1] WEN Zi-qiang;YANG Xin-yue;CHEN Yan;LU Bao-lan;XIAO Xiao-juan;ZHUANG Xiao-zhao;YU Shen-ping(Department of Radiology,The First Affiliated Hospital,Sun Yat-Sen University,Guangzhou,510080,China;Department of Radiology,Shenzhen Hospital,Peking University,Shenzhen,518036,China;Department of Radiology,Hainan Provincial People＇s Hospital,Haikou,570311,China)

机构地区：[1]中山大学附属第一医院放射科,广东广州510080 [2]北京大学深圳医院放射科,广东深圳518036 [3]海南省人民医院放射科,海南海口570311

出　　处：《消化肿瘤杂志（电子版）》2018年第1期11-15,共5页Journal of Digestive Oncology(Electronic Version)

基　　金：广东省科技计划项目(标号:2014A020212126);海南省社会发展科技专项(项目编号:SF201405)

摘　　要：目的采用扩散峰度成像(diffusion kurtosis imaging,DKI)各参数定量评价直肠癌不同组织学类型及病理分级,以探究DKI在鉴别直肠癌不同亚型及病理分级的临床诊断价值。方法对116例确诊直肠普通腺癌和16例确诊直肠黏液腺癌患者行术前直肠癌常规高分辨磁共振成像及DKI;勾画感兴趣区域(region of interest,ROI),使用DKI参数图测量肿瘤实质区和正常肠壁的DKI参数(D,K值);比较直肠普通腺癌的肿瘤实质与正常肠壁各参数,再比较直肠普通腺癌与黏液腺癌,以及普通腺癌不同分化程度的DKI参数。参数比较采用Wilcoxon和Mann-Whitney U检验。结果直肠普通腺癌肿瘤实质的K值明显高于正常肠壁(0.94±0.09 vs.0.59±0.12,P<0.001),而D值明显低于正常肠壁(1.28±0.15vs.2.20±0.34,P<0.001)。此外,直肠普通腺癌K值显著高于黏液腺癌(0.94±0.09 vs.0.68±0.09,P<0.001),D值显著低于黏液腺癌(1.28±0.15 vs.1.89±0.25,P<0.001)。而在普通腺癌不同分化程度的比较中,高中分化与低分化的DKI各参数差异均无统计学意义。结论 DKI可用于直肠癌不同组织类型的鉴别,但其在腺癌病理分级的诊断价值有待进一步研究确定。Objective To explore the clinical diagnostic value of parameters of diffusion kurtosis imaging（DKI） for distinguishing different subtypes and pathological grading of rectal adenocarcinoma.Methods Between January 2015 and December 2016, 116 patients（median age, 59.5 years; age range,29-83 years） with pathologically confirmed diagnosis of unspecified rectal adenocarcinoma and 16 patients with mucinous rectal carcinoma were prospectively included. All patients underwent routine MR examination and DKI sequence. Parameters of DKI, including diffusivity and kurtosis values, were collected by drawing regions of interest（ROIs） on tumor parenchyma and normal rectal wall. Those parameters were compared between different subtypes of adenocarcinoma or various grades in unspecified carcinoma. Wilcoxon test and Mann-Whitney U test were used for statistics analysis. Result Kurtosis value was significantly higher in unspecified rectal carcinoma than that in normal rectal wall（0.94 ±0.09 vs. 0.59 ±0.12, P〈0.001） and mucinous rectal carcinoma（0.94±0.09 vs. 0.68±0.09, P〈0.001）. Diffusivity value was significantly lower in unspecified rectal carcinoma than in normal rectal wall（1.28 ±0.15 vs. 2.20 ±0.34, P〈0.001） and mucinous rectal carcinoma（1.28±0.15 vs. 1.89±0.25, P0.001）. There were no significant differences in parameters of DKI between different pathological grading. Conclusion DKI parameters could be used in discriminating different histologic types of rectal adenocarcinoma, but its value in evaluating different pathological grades need to confirm with more studies.

关 键 词：直肠癌 扩散峰度成像 黏液腺癌 病理分级 

分 类 号：R445.2[医药卫生—影像医学与核医学]