3.0T磁共振成像术前诊断直肠癌壁外脉管侵犯的价值及相关因素  

Value and related factors of preoperative diagnosis of extramural vascular invasion of rectal cancer by 3.0T magnetic resonance imaging

作　　者：王玉娟 陈勇[2] 吕茜婷 马爱玲[2] 何玉鹏 高知玲[2] Wang Yujuan;Chen Yong;Lyu Qianting;Ma Ailing;He Yupeng;Gao Zhiling(School of Clinical Medicine, Ningxia Medical University, Yinchuan 750004, China;Department of Radiology, the General Hospital of Ningxia Medical University, Yinchuan 750004, China)

机构地区：[1]宁夏医科大学临床医学院,银川750004 [2]宁夏医科大学总医院放射科,银川750004

出　　处：《中华肿瘤杂志》2019年第8期610-614,共5页Chinese Journal of Oncology

基　　金：宁夏回族自治区重点研发计划科技惠民项目(2016KJHM63);宁夏医科大学重点项目(XZ2016005).

摘　　要：目的探讨3.0T高分辨磁共振成像(MRI)术前诊断直肠癌壁外脉管侵犯(EMVI)的价值及直肠癌EMVI的MRI相关因素。方法回顾性分析40例直肠癌患者的临床和影像学资料。以术后病理诊断为金标准,评估高分辨MRI术前诊断直肠癌EMVI的诊断效能,并分析EMVI与临床及MRI特征的关系。结果40例患者中,MRI诊断EMVI阳性19例,EMVI阴性21例。病理诊断EMVI阳性10例,EMVI阴性30例。MRI诊断EMVI的灵敏度为100%,特异度为70.0%,准确度为77.5%。术前MRI与术后病理学诊断直肠癌EMVI具有中度一致性(Kappa=0.538,P<0.001)。病理EMVI阳性与MRI测定的肿瘤大小(P=0.028)、分化程度(P<0.001)、浸润深度(P=0.002)、淋巴结转移(P=0.001)、肝转移(P=0.011)、瘤体表观扩散系数(P=0.010)及指数化表观扩散系数值(P=0.003)有关,同时也与病理检查下的直肠癌壁外神经侵犯有关(P=0.005)有关。结论依据直肠癌EMVI影像学评分标准,术前MRI在诊断直肠癌EMVI方面具有较高价值。Objective To evaluate the value of preoperative diagnosis of extramural vascular invasion (EMVI) of rectal cancer with 3.0T high-resolution magnetic resonance imaging (MRI) and the MRI-related factors of EMVI in rectal cancer. Methods The clinical and imaging data of 40 patients with rectal cancer were retrospectively analyzed. The postoperative pathological diagnosis was used as the gold standard to evaluate the diagnostic efficacy of preoperative diagnosis of EMVI of rectal cancer by high-resolution MRI, and to analyze the relationship between the EMVI and clinical and MRI features. Results Of the 40 patients, 19 cases were diagnosed as positive EMVI and 21 were negative by MRI. Pathological diagnosis of EMVI was positive in 10 cases and negative in 30 cases. The sensitivity, specificity and accuracy of MRI in the diagnosis of EMVI were 100%, 70.0% and 77.5%, respectively. Preoperative MRI and postoperative pathology were moderately consistent in the diagnosis of EMVI in rectal cancer (Kappa=0.538, P<0.001). Pathological EMVI positivity were related to tumor size under MRI examination (P=0.028), degree of differentiation (P<0.001), depth of invasion (P=0.002), lymph node metastasis (P=0.001), liver metastasis (P=0.011), tumor apparent diffusion coefficient (ADC) value (P=0.010) and exponential apparent diffusion coefficient (eADC) value (P=0.003). It also related to extramural nerve invasion by pathological examination (P=0.005). Conclusion According to the EMVI imaging score of rectal cancer, preoperative MRI has a high value in the diagnosis of EMVI of rectal cancer.

关 键 词：直肠肿瘤 壁外脉管侵犯 磁共振成像 表观弥散系数 

分 类 号：R735.37[医药卫生—肿瘤]