MRI平衡式稳态自由进动序列协同IVIM-DWI、Gd-DTPA增强对直肠癌壁外血管状态的预测价值  

Predictive value of balanced steady-state free precession MRI combined with IVIM-DWI and Gd-DTPA enhancement for extramural vascular status in rectal cancer

作　　者：章俊 张海青 刘燕军 夏鹏 余兵 查惠捷 ZHANG Jun;ZHANG Hai-qing;LIU Yan-jun;XIA Peng;YU Bing;ZHA Hui-jie(Department of Imaging,Lujiang County People's Hospital,Anhui Province,Hefei 231500,China;Department of Gastrointestinal Surgery,Lujiang County People's Hospital,Anhui Province,Hefei 231500,China)

机构地区：[1]安徽省庐江县人民医院影像科,安徽合肥231500 [2]安徽省庐江县人民医院普外科,安徽合肥231500

出　　处：《中国现代普通外科进展》2024年第5期369-372,共4页Chinese Journal of Current Advances in General Surgery

基　　金：中国红十字基金会2022医学赋能—领航菁英科研项目基金(XM_LHJY2022_05_20);安徽省合肥市卫生健康应用医学科研项目(Hwk2023zc022)。

摘　　要：目的:探讨MRI平衡式稳态自由进动序列(b SSFP)协同体素内不相干运动扩散加权成像(IVIM-DWI)、Gd-DTPA增强扫描术前对直肠癌壁外血管(EMVI)状态的预测价值。方法:回顾性选取就诊于安徽省庐江县人民医院病理证实的直肠癌患者105例,术前均行b SSFP序列、IVIM-DWI功能成像及Gd-DTPA增强多参数MRI扫描。结合MRI常规序列,运用基于单独b SSFP序列、IVIM-DWI功能成像及Gd-DTPA增强,两两协同以及多序列联合诊断三种七分制方案对EMVI状态术前预测。以术后病理结果作为诊断依据,首先对比T2WI序列及b SSFP序列诊断效能;然后依次绘制ROC曲线图,得出对应ROC曲线下面积(AUC)、特异度及敏感度。结果:常规T2抑脂序列对直肠壁外血管状态术前预测AUC:0.572(95%CI:0.408~0.737),特异度为0.811,敏感度为0.667;b SSPF序列AUC:0.817(95%CI:0.680~0.954),特异度为0.900,敏感度为0.733;各统计学参数均高于常规T2抑脂序列的诊断效能。多序列MRI协同诊断AUC:0.961(95%CI:0.886~1.000),特异度为0.988,敏感度为0.875,诊断效能最佳(P<0.05)。结论:磁共振b SSFP序列协同IVIM-DWI、Gd-DTPA增强多参数扫描对术前预测直肠癌EMVI侵犯具有较高临床应用价值。Objective:To investigate the predictive value of MRI balanced steady-state free precession(b SSFP)synergistic voxel incoherent motion diffusion weighted imaging(IVIM-DWI)and Gd-DTPA enhanced scanning for the status of extramural vascular invasion(EMVI)in rectal cancer before surgery.Methods:A total of 105 rectal cancer patients from the People's Hospital of Lujiang County,Anhui Province,were retrospectively selected and included.All patients were confirmed by postoperative pathology and underwent preoperative b SSFP sequences,IVIM-DWI functional imaging,and Gd-DTPA-enhanced multiparameter MRI scans.Three seven-point schemes based on individual b SSFP sequences,IVIM-DWI functional imaging,and Gd-DTPA enhancement,two-by-two synergy,and multi-sequence combined diagnosis were utilized in conjunction with conventional MRI sequences for preoperative prediction of EMVI status.The diag-nostic efficacy of T2WI and b SSFP sequences was compared with that of postoperative patho-logic results.ROC curves were plotted to obtain the corresponding area under the ROC curve(AUC),specificity,and sensitivity.Results:The AUC for predicting the preoperative vascular status outside the rectal wall was 0.572(95%CI:0.408~0.737)for the conventional T2 lipid sup-pression sequence,with a specificity of 0.811 and a sensitivity of 0.667.The AUC for the b SSPF sequence was 0.817(95%CI:0.680~0.954),with a specificity of 0.900 and a sensitivity of 0.733.All of the statistical parameters were higher than the diagnostic efficacy of conventional T2 lipid suppression sequences.The multi-sequence MRI co-diagnosis had an AUC of 0.961(95%CI:0.886~1.000),with a specificity of 0.988 and a sensitivity of 0.875(P<0.05).Conclusion:Magnetic resonance b SSFP sequence synergized with IVIM-DWI and Gd-DTPA-enhanced multipa-rameter scanning has high clinical application value for the preoperative prediction of EMVI invasion in rectal cancer.

关 键 词：直肠癌 平衡式稳态自由进动 弥散功能成像 磁共振增强 壁外血管 

分 类 号：R735.37[医药卫生—肿瘤]