高分辨率T2WI联合合成双反转恢复图像判断直肠癌T分期  

High resolution T2WI combined with synthetic double inversion recovery images for T staging of rectal cancer

作　　者：王子[1] 葛宇曦[1] 贺锋[1] 周心一[2] 窦维强 胡曙东 WANG Zi;GE Yuxi;HE Feng;ZHOU Xinyi;DOU Weiqiang;HU Shudong(Department of Radiology,Affiliated Hospital of Jiangnan University,Wuxi 214000,China;Department of Pathology,Affiliated Hospital of Jiangnan University,Wuxi 214000,China;GE Healthcare,Beijing 100176,China)

机构地区：[1]江南大学附属医院影像科,江苏无锡214000 [2]江南大学附属医院病理科,江苏无锡214000 [3]GE医疗,北京100176

出　　处：《中国医学影像技术》2022年第9期1350-1355,共6页Chinese Journal of Medical Imaging Technology

基　　金：无锡市卫生健康委科技成果与适宜技术推广项目(T202036)。

摘　　要：目的观察合成MRI(SyMRI)定量参数及高分辨率T2WI(HR-T2WI)联合合成双反转恢复(SyDIR)图用于直肠癌T分期的价值。方法回顾性分析79例经病理证实直肠腺癌,将病理T1及T2期归为肌层未突破组、T3及T4期归为肌层突破组。由2名影像科医师(分别具有低及高年资)基于HR-T2WI及联合SyDIR图行直肠癌T分期,观察其与病理结果的一致性,计算T分期诊断准确率;比较组间SyMRI定量参数值T1、T2及质子密度(PD)的差异。绘制受试者工作特征曲线,计算曲线下面积(AUC),评估HR-T2WI及其联合SyDIR图和T2值诊断直肠癌突破肌层的效能。结果79例中,病理T分期T1期3例,T2期32例,T3期27例,T4期17例。2名医师基于HR-T2WI判断直肠癌T分期与病理结果的一致性均较强(Kappa=0.626、0.784,P均<0.001),诊断准确率分别为75.95%(60/79)及86.08%(68/79);基于HR-T2WI联合SyDIR图判断直肠癌T分期与病理结果的一致性为较强及强(Kappa=0.783、0.829,P均<0.001),诊断准确率分别为84.81%(67/79)及88.61%(70/79)。低年资医师基于HR-T2WI联合SyDIR图判断直肠癌突破肌层的AUC(0.940)高于基于单一HR-T2WI(AUC=0.843,Z=2.443,P=0.015);高年资医师基于HR-T2WI联合SyDIR图的AUC(0.954)与基于单一HR-T2WI差异无统计学意义(AUC=0.943,Z=0.366,P=0.720),后者与低年资医师基于HR-T2WI联合SyDIR图差异无统计学意义(Z=0.108,P=0.918)。2名医师所测肌层未突破组T2值均高于肌层突破组(P均<0.001),其余定量参数差异均无统计学意义(P均>0.05);根据T2值判断直肠癌突破肌层的AUC为0.812。结论SyMRI定量参数T2值对判断直肠癌T分期具有一定价值;HR-T2WI联合SyDIR图有助于提高低年资影像科医师判断直肠癌T分期的效能。Objective To investigate the value of synthetic MRI(SyMRI)quantitative parameters and high resolution T2WI(HR-T2WI)combined synthetic double reverse recovery(SyDIR)images for T staging of rectal cancer.Methods Data of 79 patients with rectal adenocarcinoma confirmed by postoperative pathology were retrospectively analyzed.Patients with pathological stages T1 and T2 were enrolled in muscle layer non-breakthrough group,with T3 and T4 were enrolled in muscle layer breakthrough group.T staging of rectal cancer was performed by a junior also a senior radiologists based on HR-T2WI and combination with SyDIR images.The consistency of 2 radiologists for T staging of rectal cancer based on HR-T2WI,combination with SyDIR images and pathological T staging were analyzed,respectively,and the accuracies of T staging were calculated.SyMRI quantitative parameters,including T1,T2 and proton density(PD)values were compared between groups.Receiver operating characteristic curve was drawn,and area under the curve(AUC)was calculated to evaluate the efficacy of HR-T2WI,combination of HR-T2WI with SyDIR images and T2 value for diagnosing rectal cancer breakthrough muscle layer.Results Among 79 cases,the pathological T stages of rectal cancers included T1 in 3 cases,T2 in 32 cases,T3 in 27 cases and T4 in 17 cases.There were both fairly strong consistency in T staging of rectal cancer by 2 radiologists based on HR-T2WI with those of pathology(Kappa=0.626,0.784,both P<0.001),and the diagnostic accuracy was 75.95%(60/79)and 86.08%(68/79),respectively.Based on the combination of HR-T2WI and SyDIR images,there were fairly strong and strong consistency in T staging of rectal cancer by each radiologist and pathology(Kappa=0.783,0.829,both P<0.001),and the diagnostic accuracy was 84.81%(67/79)and 88.61%(70/79),respectively.The AUC of junior radiologist(0.940)for diagnosing rectal cancer breakthrough muscle layer based on HR-T2WI combined with SyDIR images was higher than based on HR-T2WI(AUC=0.843,Z=2.443,P=0.015),while of senior radiologist(0

关 键 词：直肠肿瘤 肿瘤分期 磁共振成像 

分 类 号：R735.3[医药卫生—肿瘤] R445.2[医药卫生—临床医学]