IVIM参数联合扩散加权成像形态特征对直肠中分化腺癌肌层外突的诊断价值  

The diagnostic value of intravoxel incoherent motion parameters combined with diffusion weighted imaging morphological features in extramuscular breakthrough of rectal moderately differentiated adenocarcinoma

作　　者：王子[1] 葛宇曦[1] 胡曙东 邵琳[1] 谢道海[2] WANG Zi;GE Yuxi;HU Shudong;SHAO Lin;XIE Daohai(Department of Radiology,the Affiliated Hospital of Jiangnan University,Wuxi 214000,China;Department of Radiology,the First Affiliated Hospital of Soochow University,Suzhou 215000,China)

机构地区：[1]江南大学附属医院影像科,江苏无锡214000 [2]苏州大学附属第一医院影像科,江苏苏州215000

出　　处：《实用放射学杂志》2021年第1期75-79,共5页Journal of Practical Radiology

摘　　要：目的探讨3.0T MR体素内不相干运动(IVIM)参数联合扩散加权成像(DWI)形态学特征对直肠中分化腺癌肌层外突破的诊断效能.方法收集60例直肠中分化腺癌患者的术前MRI图像及临床资料;测量IVIM参数,包括肿瘤内真实扩散系数(D)、假扩散系数(D∗)、灌注分数(f)和表观扩散系数(ADC)值.同时对DWI图像上肿瘤外缘是否存在高信号突起进行评估.根据肿瘤是否突破固有肌层将患者分为未突破组(T1、T2期)和突破组(T3、T4期);比较2组间的IVIM参数差异,计算DWI形态学特征的特异性和敏感性.绘制受试者工作特征(ROC)曲线,比较联合IVIM参数及DWI形态学特征与单独使用IVIM参数的诊断效能.结果未突破组和突破组的平均ADC值、D值、D∗值及f值分别为(1.11±0.10)×10-3 mm2/s、(0.96±0.07)×10-3 mm2/s、(48.5±19.34)×10-3 mm2/s、(27.3±8.7)%和(1.04±0.08)×10-3 mm2/s、(0.89±0.08)×10-3 mm2/s、(54.2±18.2)×10-3 mm2/s、(23.7±6.7)%.其中ADC值、D值在2组间存在统计学差异,P值分别为0.013、0.001.未突破组中,24/26例DWI肿瘤外缘无高信号突起,突破组中,29/34例DWI肿瘤外缘存在高信号突起.该征象在诊断突破组中的敏感性及特异性分别为85%、92%.将D值和DWI形态学特征纳入联合诊断Logistics回归分析,绘制ROC曲线,曲线下面积(AUC)值(0.921)高于单独使用D值(0.727).结论IVIM定量参数ADC值、D值以及DWI肿瘤外缘的高信号突起可以辅助鉴别直肠中分化腺癌是否突破固有肌层;二者联合诊断效能更高.Objective To investigate the diagnostic efficacy of intravoxel incoherent motion(IVIM)parameters combined withdiffusion weighted imaging(DWI)morphological features in extramuscular breakthrough of rectal moderately differentiated adenocarcinomaat 3,.0T MR.Methods Properative MRl images and the clinical data was collected from 60 patients with rectal moderately differentiatedadenocarcinoma.The IVIM parameters were measured including D,D*,f and ADC values At the same time,the presenct of high signalprotrusions in the outer edge of the tumor on the DWlimage was evaluated.Acording to the pathology,the patients were divided intothe nonr-breakthrough group(staging T1 and T2)and the breakthrough group(staging T3 and T4).The differances in IVIM parametersbetween the two groups were compared and the speificity and sensitivity of the morphological features of DWI were calculated.Then,receiver operating characteristic(ROC)curves were drawn in order to compare the diagnostic efficacy of the combined featureswith the IVIM parameters alone.Results In the non-breakthrough group and the breakthrough group,the ADC values,D values,D values and f values were(1.11±0.10)×10-3 mm2/s、(0.96±0.07)×10-3 mm2/s、(48.5±19.34)×10-3 mm2/s、(27.3±8.7)% and (1.04±0.08)×10-3 mm2/s、(0.89±0.08)×10-3 mm2/s、(54.2±18.2)×10-3 mm2/s、(23.7±6.7)%respectively.The ADC valueand D value showed statistical differences betwen the two groups,with P values of 0.013 and 0.001 respectively.In the non-breakthroughgroup,24 of 26 cases did not show a high signal protrusion in the outer edge of the tumor on DW1,while in the breakthrough group,29 of 34 patients showed the sign.The senstivity and specificity of high signal protrusion in the outer edge in the diagnostic breakthrough group were 85%and 92%respectively.D values and DWI mor-phological features were included in the combined diagnosticLogistic regression model.The ROC curve showed that the area under the curve(AUC)value of the combined diagnosis(0.921)was higher than the D value alone(0.

关 键 词：直肠癌 体素内不相干运动 T分期 

分 类 号：R735.37[医药卫生—肿瘤] R445.2[医药卫生—临床医学]