DCE-MRI定量参数联合高分辨率T2WI预测直肠腺癌病理N分期的价值  

Value of quantitative parameters of dynamic contrast-enhanced MRI combined with high-resolution T 2WI findings in predicting pathological N-stage of rectal adenocarcinoma

作　　者：杨彦松 李君[1] 张明珠[1] 邱永娟[1] 王勇 李鼎[2] 张益飞[1] YANG Yan-song;LI Jun;ZHANG Ming-zhu(Department of Radiology,Nantong Tumor Hospital,Jiangsu 226361,China)

机构地区：[1]南通市肿瘤医院影像科,江苏南通226361 [2]南通市肿瘤医院胃肠外科,江苏南通226361

出　　处：《放射学实践》2023年第4期459-467,共9页Radiologic Practice

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

摘　　要：目的:探讨动态增强MRI(DCE-MRI)定量参数联合高分辨率MRI(HR-MRI)征象预测直肠腺癌病理N分期(pN)的价值。方法:回顾性将2019年1月-2021年9月在本院行DCE-MRI和HR-MRI且术后病理证实为直肠腺癌的98例患者纳入研究。其中,男62例、女36例;平均年龄(64.9±8.3)岁;术后病理结果显示41例直肠腺癌患者有淋巴结转移和或癌结节(pN1~pN2组),57例无淋巴结转移和癌结节(pN0组)。由2位阅片者独立分析HR-MRI表现并测量病灶的DCE-MRI定量参数。比较两组间临床危险因素、HR-MRI征象及DCE-MRI定量参数值的差异,采用单因素和多因素logistic回归分析筛选出预测pN1~pN2的独立风险因素。采用ROC曲线分析各项风险因素和logistic回归模型对直肠腺癌pN分期的预测效能。采用χ^(2)检验比较不同参数和logistic回归模型预测直肠腺癌pN分期的敏感度和特异度。结果:相较于pN0组,pN1~pN2组中患者年龄更低[(62.9±9.1)vs.(66.4±7.4)岁,P=0.038],血清CEA浓度异常率更高[19(46.3%)vs.12(21.1%),P=0.008],MRI-T分期为T3期患者的比例更高[27(65.9%)vs.22(38.6%),P=0.008],MRI-N分期为N1~N2期患者的比例更高[26(63.4%)vs.12(21.1%),P<0.001]、直肠系膜/筋膜(MRF)受累阳性率更高[10(24.4%)vs.4(7.0%),P=0.015]、壁外血管侵犯(EMVI)阳性率更高[16(39.0%)vs.8(14.0%),P=0.005]、K_(trans)值更低[0.242(0.177,0.317)vs.0.378(0.291,0.547)min^(-1),P<0.001]。多因素logistic回归分析结果表明CEA升高、MRI N1~N2期和K_(trans)<0.298 min^(-1)是直肠腺癌pN1~pN2的独立预测因素[OR值分别为3.143、5.571和0.167,P分别为0.037、0.001和<0.001]。血清CEA浓度升高、MRI N1~N2期联合K_(trans)<0.298 min^(-1)的logistic回归模型预测pN1~pN2的曲线下面积(AUC)为0.839(95%CI:0.761~0.917),敏感度为90.2%、特异度为61.4%。与单变量(CEA浓度、MRI N分期和K_(trans))模型相比,联合模型预测直肠腺癌pN分期的敏感度最高(χ^(2)值分别为18.247、8.289和3.398,P均<0.05),但特异度低Objective:To investigate the value of quantitative parameters of dynamic contrast-enhanced MRI(DCE-MRI)combined with high-resolution MRI(HR-MRI)in predicting pathological N stage of rectal adenocarcinoma.Methods:98 patients with rectal adenocarcinoma confirmed by pathology[62 males and 36 females;mean age(64.9±8.3)years]who underwent DCE-MRI and HR-MRI scan before radical resection in our hospital from January 2019 to September 2021 were retrospectively enrolled.The HR-MRI findings were re-interpreted by two radiologists.The quantitative parameters of DCE-MRI were measured by two radiologists with tissue 4D software.Taking the postoperative pathological results as the gold standard,the patients were divided into pathological positive N stage(pN1~pN2)and pathological negative N stage(pN0).The differences of clinical risk factors,HR-MRI fin-dings and DCE-MRI quantitative parameters between the two groups were analyzed.The factors predicting pN1~pN2 were screened by univariate and multivariate logistic regression analysis.Receiver operating characteristic curve(ROC)were used to calculate the predictive effect of various risk factors and logistic regression model on the pN stage of rectal adenocarcinoma.Chi-square test was used to compare the sensitivity and specificity.Results:Postoperative pathological results confirmed that 41 cases were pN1~pN2 and 57 cases were pN0.Compared with pN0,the pN1~pN2 patients were younger[(62.9±9.1)vs.(66.4±7.4)yrs,P=0.038]and had higher rate of CEA abnormality[19(46.3%)vs.12(21.1%),P=0.008],higher rate of MRI reported T3-stage[27(65.9%)vs.22(38.6%),P=0.008],higher rate of MRI reported N1~N2 stage[26(63.4%)vs.12(21.1%),P<0.001],higher MRI reported positive rate of mesorectal fasciae(mrMRF)involvement[10(24.4%)vs.4(7.0%),P=0.015],and higher positive rate[16(39.0%)vs.8(14.0%),P=0.005]of MRI reported extramural vascular invasion(mrEMVI),lower K_(trans) value[0.242(0.177,0.317)vs.0.378(0.291,0.547)min^(-1),P<0.001].Multivariate logistic regression analysis showed that abnormal CEA leve

关 键 词：直肠肿瘤 N分期 动态增强扫描 磁共振成像 联合诊断模型 

分 类 号：R445.2[医药卫生—影像医学与核医学] R735.3[医药卫生—诊断学]