动态对比增强MRI定量参数联合高分辨率MRI预测直肠腺癌脉管侵袭的研究  

A study of predicting lymphovascular invasion in rectal adenocarcinoma using dynamic contrast-enhanced MRI quantitative parameters combined with high-resolution MRI

作　　者：张明珠 杨彦松 沈月红 张益飞 李月玥 朱兴华[3] 崔磊[1] ZHANG Mingzhu;YANG Yansong;SHEN Yuehong;ZHANG Yifei;LI Yueyue;ZHU Xinghua;CUI Lei(Department of Imaging,the Second Affiliated Hospital of Nantong University,Nantong,Jiangsu Province 226001,China;Department of Imaging,the Affiliated Tumor Hospital of Nantong University,Nantong,Jiangsu Province 226361,China;Department of Pathology,the Affiliated Tumor Hospital of Nantong University,Nantong,Jiangsu Province 226361,China)

机构地区：[1]南通大学第二附属医院影像科,江苏南通226001 [2]南通大学附属肿瘤医院影像科,江苏南通226361 [3]南通大学附属肿瘤医院病理科,江苏南通226361

出　　处：《实用放射学杂志》2022年第11期1799-1802,1814,共5页Journal of Practical Radiology

基　　金：南通市卫生和计划生育委员会科研课题专项面上项目(MA2020007);南通大学临床研究专项青年项目(2019LQ014).

摘　　要：目的探讨动态对比增强磁共振成像(DCE-MRI)定量参数结合高分辨率磁共振成像(HR-MRI)影像表现预测直肠腺癌脉管侵袭(LVI)的价值.方法选取经术后病理证实的直肠腺癌患者82例.2位医师重新判读HR-MRI影像表现,并在TISSUE 4D软件中勾画直肠肿瘤全体积,获得DCE-MRI定量参数.以术后病理结果为金标准将患者分为LVI阳性组和LVI阴性组,分析2组间差异性,单因素和多因素Logistic回归分析筛选LVI的预测因素.受试者工作特征(ROC)曲线计算模型预测LVI的效能.结果LVI阳性组的逆向转运常数(K_(ep))值明显低于LVI阴性组[0.84(0.74,1.79)min^(-1) vs1.50(1.08,3.00)min^(-1),P=0.003],血管外细胞外间隙容积分数(V_(e))值高于LVI阴性组(0.36±0.08vs0.30±0.11,P=0.026).LVI阳性组的淋巴结转移发生率(57.9%vs27.0%,P=0.013)和环周切缘(CRM)阳性率(42.1%vs12.7%,P=0.012)高于LVI阴性组,余指标无统计学差异.多因素Logistic回归分析显示年龄、CRM和V_(e)值是直肠腺癌LVI的独立影响因素[优势比(OR)=0.909、0.176和4238.960,P=0.012、0.010和0.018],联合预测直肠腺癌LVI的曲线下面积(AUC)为0.799.结论直肠腺癌LVI阳性的患者具有较低的K_(ep)值、较高的V_(e)值、较高的淋巴结转移发生率和较高的CRM阳性率.年龄、CRM联合V_(e)值可在术前较准确预测直肠腺癌LVI.Objective To explore the value of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)quantitative parameters combined with high-resolution magnetic resonance imaging(HR-MRI)in predicting lymphovascular invasion(LVI)of rectal adenocarcinoma.Methods A total of 82 patients with rectal adenocarcinoma confirmed by postoperative pathological results were selected.HR-MRI imaging findings were re-interpreted by two physicians,and the total volume of rectal tumors were outlined in TISSUE 4D software to obtain the DCE-MRI quantitative parameters.By taking the postoperative pathological results as the gold standard,the patients were divided into the LVI positive group and the LVI negative group.The differences between the two groups were analyzed.The prediction factors of LVI were identified by univariate and multivariate Logistic regression analyses,and their effectiveness forpredictingLVI was evaluatedbythereceiveroperating characteristic(ROC)curve.Results Patients in the LVI positive group had significantly lower K_(ep) value[0.84(0.74,1.79)min^(-1) vs 1.50(1.08,3.00)min^(-1),P=0.003]and significantly higher V_(e) value(0.36±0.08vs0.30±0.11,P=0.026)than patients in the LVI negative group.Patients in the LVI positive group also had a higher incidence of lymph node metastasis(57.9%vs 27.0%,P=0.013)and positive rate of circumferential resection margin(CRM)(42.1%vs 12.7%,P=0.012)than patients in the LVI negative group.Other parameters were no statistically different between the two groups.Multivariate Logistic regression analysis showed that age,CRM,and V_(e) value were independent influencing factors of LVI in rectal adenocarcinoma[odds ratio(OR)=0.909,0.176 and 4238.960,P=0.012,0.010 and 0.018,respectively].The area under the curve(AUC)of the combined model for predicting LVI in rectal adenocarcinoma was 0.799.Conclusion Patients with positive LVI of rectal adenocarcinoma have lower K_(ep) value,higher V_(e) value,higher incidence of lymph node metastasis and higher CRM positive rate.Age and CRM combined with V

关 键 词：直肠腺癌 动态对比增强磁共振成像 高分辨率磁共振成像 脉管侵袭 

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