DKI推算序列优化直肠癌术前分期的应用研究  

The Value of Calculated Diffusion-Weighted Images Based on Diffusion Kurtosis Imaging Sequence in Optimizing Preoperative Staging Scanning Procedure of Rectal Cancer

作　　者：夏益涵 朱兰[1] 谭晶文 傅萌[1] 潘自来[1] 严福华[1] 张欢[1] XIA Yihan;ZHU Lan;TAN Jingwen(Departmenti of Radiology,Ruijin Hospital,Shanghai Jiaotong University School of Medicine,Shanghai 200025,P.R.China)

机构地区：[1]上海交通大学医学院附属瑞金医院放射科,200025

出　　处：《临床放射学杂志》2022年第1期106-111,共6页Journal of Clinical Radiology

基　　金：国家自然基金资助项目(编号:81771789);上海市科委科技创新行动临床创新领域基金资助项目(编号:18411953000);上海市青年科技英才扬帆计划基金资助项目(编号:20YF1427200)。

摘　　要：目的探索基于扩散峰度成像(DKI)扫描参数的推算序列代替常规扩散加权成像(DWI)序列扫描的应用价值。方法回顾性分析2019年11月至2020年10月瑞金医院确诊的直肠癌患者62例,其手术前2周内均行MR扫描,将DKI图像经后处理推算出b=1000 s/mm;扩散图像,两名医师分别对推算序列与常规DWI序列的b=1000 s/mm;的图像进行比较。结果 DKI推算序列的主观图像质量、信噪比(SNR)、对比噪声比(CNR)及信号强度比(SIR)均优于常规DWI序列(P<0.050)。两者术前T分期的准确率分别为91.94%(57/62)、74.19%(46/62),差异有统计学意义(P<0.050);N分期的准确率分别为70.97%(44/62)、66.13%(41/62),差异无统计学意义(P>0.050)。结论 DKI推算序列具有代替常规DWI序列、减少扫描时间、优化扫描流程及T分期诊断效能的潜在应用价值。Objective To explore the application value of calculated images based on diffusion kurtosis imaging(DKI) sequence in preoperative staging of rectal cancer by comparing and analyzing the differences between calculated images and conventional diffusion-weighted images(DWI). Methods A total of 62 patients with pathologically confirmed rectal cancer were involved in this retrospective study in our hospital from November 2019 to October 2020.All the patients received rectal magnetic resonance(MR) examinations with a 3.0 T imager(Magnetom Prisma, Siemens Healthcare, Erlangen, Germany) within 2 weeks before surgery. The lower b value(b=0 and 700 s/mm;) images of DKI(b=0,700,1400,and 2100 s/mm;) sequence were selected to calculate the diffusion images with b value of 1000 s/mm;in Siemens SyngoVia postprocessing station. Two radiologists independently assessed subjective image quality(IQ) parameters of both sequences, and the signal-to-noise ratio(SNR),contrast-to-noise ratio(CNR),and signal intensity ratio(SIR)were also quantitatively evaluated.The diagnostic performance of local T and N staging based on the two sequences was analyzed and compared.Friedman test, Wilcoxon paired test, McNemar test or Fisher exact probability method were used for statistical analysis. Results The subjective IQ scores, SNR,CNR,and SIR of rectal tumor in calculated images were significantly superior to conventional DWI sequence(P< 0.050).The accuracy of calculated images(91.94%,57/62) was higher than that of conventional DWI sequence(74.19%,46/62) in the T staging(P<0.050),while in the N staging, the difference(70.97%,44/62 vs 66.13%,41/62) was not statistically significant(P> 0.050). Conclusion The calculated images based on DKI sequence provided significantly better IQ and lesion conspicuity than the conventional DWI sequence, and it can improve the accuracy of preoperative T staging of rectal cancer.Therefore, it is applicable to replace conventional DWI sequence for reducing examination time and optimizing the scanning procedure.

关 键 词：直肠癌 扩散峰度成像(DKI) 扩散加权成像(DWI) 术前分期 诊断效能 

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]