磁共振成像在直肠腺癌及粘液腺癌诊断中的应用研究  

Application of MRI in rectal mucinous adenocarcinoma

作　　者：陈照宏[1] 高玉颖[1] 李晓晗[2] 张小薄[3] 尹建东[1] CHEN Zhaohong;GAO Yuying;LI Xiaohan;ZHANG Xiaobo;YIN Jiandong(Department of Radiology,Shengjing Hospital of China Medical University,Shenyang 110031,China;Department of Pathology,Shengjing Hospital of China Medical Uni/versity,Shenyang 110031,China;Department of Surgery,Shengjing Hospital of China Medical University,Shenyang 110031,China)

机构地区：[1]中国医科大学附属盛京医院放射科,辽宁沈阳110031 [2]中国医科大学附属盛京医院病理科,辽宁沈阳110031 [3]中国医科大学附属盛京医院外科,辽宁沈阳110031

出　　处：《医学影像学杂志》2023年第1期75-78,共4页Journal of Medical Imaging

摘　　要：目的 评价磁共振成像在直肠粘液腺癌诊断中的应用价值,为术前精准诊断及治疗提供依据。方法 选取2014年1月~2018年1月我院手术病理确诊的直肠癌患者384例。以术后病理结果为金标准,观察MRI及肠镜病理对直肠粘液腺癌及直肠腺癌诊断的敏感性、特异性、符合率。观察ADC值在直肠粘液腺癌及直肠腺癌中的差异,ROC曲线评价MRI对直肠粘液腺癌的诊断价值。结果 MRI对直肠黏液腺癌诊断敏感性为84.4%,特异性为99.4%,符合率为98.2%,MRI对直肠腺癌诊断敏感性为99.4%,特异性为84.4%,符合率为98.2%;肠镜下病理对直肠黏液腺癌诊断的敏感性为34.4%,特异性为100%,符合率为98.2%,肠镜下病理对直肠腺癌诊断的敏感性为98.6%,特异性为100%,符合率为98.7%。MRI对直肠黏液腺癌T2、T3、T4敏感性分别为66.7%、90.0%、100%,特异性分别为95.8%、94.1%、100%,与病理T分期符合率分别为92.6%、92.6%、100%,ADC值在直肠粘液腺癌高于直肠腺癌(P<0.001)。ROC曲线显示,AUC=0.796(95%:0.726~0.865),以0.953×10-3为临界值,敏感度为78.1%,特异度为68.7%。结论 MRI在直肠黏液腺癌的诊断及T分期中具有较高的敏感度及特异度,可结合ADC值对直肠黏液腺癌进行诊断,具有一定的临床应用价值。Objective To evaluate the value of MRI in rectal mucinous adenocarcinoma so as to provide basis for precision diagnosis and therapy. Methods Three hundred and eighty-four patients diagnosed as rectal cancer by post-operation pathology were collected from Jan. 2014 to Jan. 2018. Three hundred and fifty-two cases were rectal adenocarcinoma(tubular adenocarcinoma and papillary adenocarcinoma) and 32 cases were rectal mucinous adenocarcinoma. Post-operation pathology was golden standard. Sensitivity, specificity and coincidence rate of MRI and enteroscope pathology to diagnose rectal mucinous adenocarcinoma and rectal adenocarcinoma were observed. Sensitivity, specificity and coincidence rate of MRI to diagnose rectal mucinous adenocarcinoma T stage were observed. The differences of ADC value between rectal mucinous adenocarcinoma and rectal adenocarcinoma were observed by ROC curve. Results The sensitivity, specificity and coincidence rate of MRI in the diagnosis of rectal mucinous adenocarcinoma and rectal adenocarcinoma were 84.4% vs 99.4%,99.4% vs 84.4%,98.2% vs 98.2%. The sensitivity, specificity and coincidence rate of enteroscope pathology in the diagnosis of rectal mucinous adenocarcinoma and rectal adenocarcinoma were 34.4% vs 98.6%, 100% vs 100%, 98.2% vs 98.7%. The sensitivity, specificity and coincidence rate of MRI in the diagnostic T2, T3, T4 stage of rectal mucinous adenocarcinoma were 66.7% vs 90.0% vs 100%, 95.8% vs 94.1% vs 100%, 92.6% vs 92.6% vs 100%. ADC value in rectal mucinous adenocarcinoma was higher than in rectal adenocarcinoma(P<0.001). ROC curve showed AUC was 0.796(95%:0.726~0.865), setting 0.953×10-3as critical value, the sensitivity was 78.1%,specificity was 68.7%.Conclusion MRI gains high sensitivity and specificity in the diagnosis and T stage of rectal mucinous adenocarcinoma, ADC value may be combined to diagnosis and the clinical value is acceptable.

关 键 词：直肠粘液腺癌 磁共振成像 表观扩散系数 

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