全容积ADC直方图分析联合ADC值术前预测直肠癌肿瘤沉积的价值  

The value of whole-volume ADC histogram analysis combined with ADC value in preoperatively prediction of tumor deposits in rectal cancer

作　　者：冯飞文 刘原庆 胡粟[1,2] 胡春洪[1,2] FENG Feiwen;LIU Yuanqing;HU Su;HU Chunhong(Department of Radiology,the First Affiliated Hospital of Soochow University,Suzhou 215006,China;Institute of Medical Imaging,Soochow University,Suzhou 215006,China)

机构地区：[1]苏州大学附属第一医院放射科,苏州215006 [2]苏州大学影像医学研究所,苏州215006

出　　处：《磁共振成像》2024年第4期88-92,共5页Chinese Journal of Magnetic Resonance Imaging

摘　　要：目的探讨基于肿瘤全容积表观扩散系数(apparent diffusion coefficient,ADC)直方图参数联合ADC值在术前预测直肠癌肿瘤沉积(tumor deposits,TDs)中的应用价值。材料与方法回顾性分析苏州大学附属第一医院2016年6月至2023年6月术前行直肠MRI检查且经病理确诊的111例直肠癌患者的临床及影像学资料,依据病理结果将其分为TDs阳性组(n=30)和TDs阴性组(n=81),在ADC图像上手动勾画每一层肿瘤病灶感兴趣区(region of iterest,ROI)并提取ADC直方图参数,包括第10百分位数(ADC_(10%))、第90百分位数(ADC_(90%))、最大值(ADC_(max))、最小值(ADC_(min))、均数(ADC_(mean))、中位数(ADC_(median))、峰度及偏度;同时测量肿瘤最大层面的平均ADC值。分析比较两组患者间ADC值及ADC直方图参数的差异,将差异具有统计学意义的参数纳入多因素logistic回归分析构建联合模型,利用ROC曲线分析ADC值、全容积ADC直方图参数及两者联合模型的预测效能。采用DeLong检验比较各AUC间的差异。结果ADC值、ADC_(10%)、ADC_(90%)、ADC_(max)、ADC_(mean)、ADC_(median)及峰度在TDs阳性组和阴性组间差异具有统计学意义(P<0.05),以ADC_(90%)的预测效能最高(AUC、敏感度、特异度分别为0.778、80.0%、65.4%)。由ADC值、ADC_(10%)、ADC_(90%)、ADC_(mean)构建的联合模型AUC、敏感度、特异度分别为0.940、86.7%、93.8%,其诊断效能优于ADC值(AUC为0.645)及各全容积ADC直方图参数(AUC为0.649~0.778),差异均有统计学意义(P<0.05)。结论全容积ADC直方图参数及肿瘤最大层面的ADC值可用于术前预测直肠癌TDs,尤其当两者联合时具有较高的预测效能。Objective:To explore the value of tumoral whole-volume apparent diffusion coefficient(ADC)histogram parameters combined with ADC value in preoperative prediction of tumor deposits(TDs)in rectal cancer.Materials and Methods:The clinical and radiological data of 111 patients with pathologically confirmed rectal cancer who underwent preoperative rectal MRI examinations from June 2016 to June 2023 were retrospectively analyzed.The patients were grouped as TDs-positive group(n=30)and TDs-negative group(n=81)according to the pathological results.ROI was manually delineated on each slice of the tumor on the ADC images and histogram parameterswere obtained,including the ADC_(10%),ADC_(90%),maximum value(ADC_(max)),minimum value(ADC_(min)),mean value(ADC_(mean)),median value(ADC_(median)),kurtosis,and skewness.And the ADC value of the largest level of the tumor was measured.The differences in ADC value and ADC histogram parameters between the two groups were compared.A combined model was constructed based on factors with statistically significant differences using multivariate logistic regression analysis.Receiver operating characteristic curve(ROC)analysis was used to analyze the predictive performance of ADC value,whole-volume ADC histogram parameters,and the combined model.DeLong test was used to compare the differences of AUCs.Results:The ADC value,ADC_(10%),ADC_(90%),ADC_(max),ADC_(mean),ADC_(median),and kurtosis were statistically different between the TDs-positive and TDs-negative groups(P<0.05).ADC_(90%)had the highest predictive performance with an AUC of 0.778(sensitivity,80.0%;specificity,65.4%).The diagnostic performance of the combined model(AUC,0.940;sensitivity,86.7%;specificity,93.8%)was superior to that of ADC value alone(AUC,0.645)and whole-volume ADC histogram parameters(AUC ranging from 0.649 to 0.778)(P<0.05).Conclusions:Whole-volume ADC histogram parameters and the ADC value of the largest level of tumor can be used for preoperative prediction of TDs in rectal cancer,and the combined model can improv

关 键 词：胃肠道肿瘤 直肠癌 肿瘤沉积 扩散加权成像 直方图 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R735.37[医药卫生—诊断学]