剪切波弹性成像评估局部晚期直肠癌新辅助放化疗后T再分期的应用价值  

Application of shear wave elastography in T restaging for locally advanced rectal cancer after neoadjuvant chemoradiotherapy

作　　者：钱清富 卓敏玲 唐懿 林晓东[1] 薛恩生[1] 陈志奎[1] Qian Qingfu;Zhuo Minling;Tang Yi;Lin Xiaodong;Xue Ensheng;Chen Zhikui(Department of Ultrasound,Union Hospital of Fujian Medical University,Fujian Provincial Institute of Ultrasonic Medicine,Fuzhou 350001,China)

机构地区：[1]福建医科大学附属协和医院超声科,福建省超声医学研究所,福州350001

出　　处：《中华超声影像学杂志》2024年第1期71-76,共6页Chinese Journal of Ultrasonography

基　　金：福建医科大学启航基金项目(2022QH1046)。

摘　　要：目的探讨剪切波弹性成像(SWE)在局部晚期直肠癌新辅助放化疗(nCRT)后T再分期评估中的应用价值。方法前瞻性收集2021年10月至2023年3月在福建医科大学附属协和医院接受nCRT,并接受全直肠系膜切除术的局部晚期直肠癌患者271例,记录临床、经直肠腔内超声(ERUS)和SWE检查资料。分析并筛选出低T分期的独立预测因子,构建Logistic回归模型。采用独立的测试集数据验证模型的预测性能,并与超声医师的诊断结果进行比较。结果二元多因素Logistic回归分析结果显示,病灶周围系膜杨氏模量平均值(Emean)、病灶厚径、肠周肿大淋巴结是诊断低T分期的独立预测因子,OR值分别为1.089、1.214、0.183。采用病灶周围系膜Emean、病灶厚径、肠周肿大淋巴结建立的Logistic回归模型A和采用病灶周围系膜Emean建立的Logistic回归模型B均具有较高的诊断效能(ROC曲线下面积分别0.931、0.918,准确性分别为0.888、0.887),两者的诊断准确性差异无统计学意义(P=1.000),但显著高于超声医师(均P<0.001)。结论SWE可以有效预测局部晚期直肠癌nCRT后肿瘤是否为低T分期,对评估直肠癌nCRT后T再分期具有较高的应用价值。Objective To investigate the application value of shear wave elastography(SWE)in the evaluation of T re-staging after neoadjuvant chemoradiotherapy(nCRT)for locally advanced rectal cancer.Methods Clinical,endorectal ultrasound(ERUS)and SWE data of 271 patients with locally advanced rectal cancer who underwent nCRT and total mesorectal excision in Fujian Medical University Union Hospital from October 2021 to March 2023 were prospectively collected.The independent predictors for low T staging were analyzed and screened,and the Logistic regression model was constructed.An independent test set was used to validate the prediction performance of the models and compare them with the diagnostic results of sonographers.Results Binary multivariate Logistic regression analysis showed that Emean of the mesentery around the lesion,thickness,and enlarged lymph nodes around the rectum were the independent predictors for low T staging,and the odds ratios were 1.089,1.214,0.183,respectively.The Logistic regression model A established by Emean,thickness and enlarged lymph nodes around the lesion and the Logistic regression model B established by Emean around the lesion had high diagnostic efficiencies(area under the ROC curve were 0.931,0.918,respectively,the accuracy were 0.888 and 0.887,respectively).There was no significant difference in diagnostic accuracy between the two models(P=1.000),and both models were significantly higher than that of sonographers(all P<0.001).Conclusions SWE can effectively predict whether the tumor is of low T staging after nCRT in locally advanced rectal cancer,and can be used as an important supplement to ERUS in evaluating the T re-staging of rectal cancer after nCRT.

关 键 词：超声检查 经直肠腔内 直肠癌 新辅助放化疗 弹性成像 

分 类 号：R445.1[医药卫生—影像医学与核医学] R735.37[医药卫生—诊断学]