MRI动态增强和弥散加权成像在直肠腺癌术前壁外血管侵犯中的评估价值  

Value of dynamic contrast-enhanced magnetic resonance imaging and diffusion-weighted imaging in evaluating extramural vascular invasion of rectal adenocarcinoma before operation

作　　者：马东东[1] 董修明[1] MA Dongdong;DONG Xiuming(Department of Imaging Center,Bozhou People's Hospital,Bozhou 236804,China)

机构地区：[1]安徽省亳州市人民医院影像中心,安徽亳州236804

出　　处：《医学影像学杂志》2023年第3期460-465,共6页Journal of Medical Imaging

摘　　要：目的探讨动态增强(DCE)和弥散加权磁共振成像(DWI-MRI)在直肠腺癌术前壁外血管侵犯(EMVI)中的评估价值。方法选取经病理确诊直肠腺癌患者52例,其中病理诊断EMVI阳性27例、阴性25例。所有患者术前接受MRI常规序列、DCE和DWI-MRI检查,获得平均定量灌注参数[体积转移常数(K^(trans))、细胞外血管外体积分数(V e)和反流速率常数(K_(ep))]和标准表观扩散系数(ADC)值,根据MRI表现将52例患者分为MRI-EMVI阳性组23例和阴性组29例。结果MRI-EMVI阳性组癌胚抗原(CEA)、肿瘤浸润深度、环周浸润率和Ki67阳性表达率均显著高于阴性组,组织分化程度降低,T分期增加,N阳性率升高,差异有统计学意义(P<0.05)。与病理EMVI诊断结果比较,MRI-EMVI具有较好的一致性(Kappa=0.789,P<0.001)。MRI-EMVI阳性组K^(trans)和K_(ep)值显著高于阴性组,而ADC值显著降低,差异有统计学意义(P<0.05)。Spearman检验显示ADC值与K^(trans)和K_(ep)值呈现明显负相关(r=-0.755和-0.669,P<0.001)。受试者工作特征曲线(ROC)显示,K^(trans)值、K_(ep)值、ADC值以及联合诊断MRI-EMVI阳性的曲线下面积(AUC)分别为0.781、0.732、0.704和0.879。结论DCE和DWI-MRI术前评估直肠腺癌EMVI与病理结果有较好的一致性,能够反映肿瘤的恶性侵袭程度,获得K^(trans)值、K_(ep)值和ADC值定量参数联合诊断EMVI效能较高,有重要的临床应用潜力。Objective To evaluate the value of dynamic contrast-enhanced(DCE)and diffusion-weighted magnetic resonance imaging(DWI-MRI)in the evaluation of extramural vascular invasion(EMVI)for rectal adenocarcinoma before operation.Methods A total of 52 patients with rectal adenocarcinoma diagnosed by surgery and pathology were retrospectively summarized.There were 27 patients with EMVI positive and 25 patients with negative pathological diagnosis.All patients underwent routine sequence,DCE and DWI-MRI before operation.The mean quantitative perfusion parameters[volume transfer constant(K^(trans)),extracellular vascular volume fraction(V e)and reflux rate constant(K_(ep))]and standard apparent diffusion coefficient(ADC)value were obtained.52 patients were divided into EMVI positive group(n=23)and negative group(n=29)according to MRI standard.Results Carcinoembryonic antigen(CEA),depth of tumor invasion,circumferential invasion rate and Ki67 positive expression rate in MRI-EMVI positive group were significantly higher than those in negative group,the degree of tissue differentiation decreased,T stage increased,and N positive rate increased,too(P<0.05).Compared with pathological EMVI,MRI-EMVI had good consistency(Kappa=0.789,P<0.001).The values of K^(trans)and K_(ep)in MRI-EMVI positive group were significantly higher than those in negative group,while ADC value decreased significantly(P<0.05).Spearman test showed that ADC value was significantly negatively correlated with K^(trans)and K_(ep)value(r=-0.755 and-0.669,P<0.001).Receiver operating curve(ROC)showed that area under the curve(AUC)of K^(trans)value,K_(ep)value,ADC value and combined diagnosis for MRI-EMVI were 0.781,0.732,0.704 and 0.879,respectively.Conclusion DCE and DWI-MRI preoperative evaluation of EMVI in rectal adenocarcinoma have good consistency with pathological result,can reflect malignant invasion degree of the tumor,and obtain quantitative parameters of K^(trans)value,K_(ep)value and ADC value.The combined diagnosis of EMVI has high efficiency and importa

关 键 词：直肠腺癌 壁外血管侵犯 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]