不同肠道准备方式对直肠癌患者超高b值DWI图像质量的影响  

Effect on image quality of ultra-high b-values diffusion weighted imaging in patients with rectal cancer by using different bowel preparation methods

作　　者：郝勇飞 李婉清 赵婉婷 王虹 张广文 冯岩 李延静[1] 张劲松 HAO Yongfei;LI Wanqing;ZHAO Wanting;WANG Hong;ZHANG Guangwen;FENG Yan;LI Yanjing;ZHANG Jinsong(Medical School of Yan'an University,Yan'an 716000,China;Department of Radiology,Xijing Hospital,Air Force Medical University,Xi'an 710032,China)

机构地区：[1]延安大学医学院,延安716000 [2]空军军医大学西京医院放射诊断科,西安710032

出　　处：《磁共振成像》2024年第6期115-122,共8页Chinese Journal of Magnetic Resonance Imaging

基　　金：国家自然科学基金项目(编号:82371918)。

摘　　要：目的探讨直肠癌患者MRI检查前采用不同肠道准备方式(番泻叶肠道准备和单纯限制饮食)对扩散加权成像(diffusion weighted imaging,DWI)超高b值DWI_(b2000)(b=2000 s/mm^(2))和常规b值DWI_(b1000)(b=1000 s/mm^(2))图像质量的影响。材料与方法回顾性分析番泻叶肠道准备组和单纯限制饮食组共203例直肠癌患者的DWI(DWI_(b1000)和DWI_(b2000))图像质量及相关影响因素。评估组间肠道准备质量指标(包括直肠扩张程度、直肠内容物性质、直肠肠腔气体量、肿瘤层面肠腔气体量)和DWI图像的磁敏感伪影程度(整体伪影、肿瘤区伪影)。采用Mann-Whitney U检验或t检验比较两组间肠道准备质量评分和DWI图像伪影评分的差异。肿瘤区DWI_(b2000)伪影评分≤3分被定义为肿瘤区DWI_(b2000)临床显性伪影,使用单因素和多因素logistic回归模型分析肿瘤区DWI_(b2000)临床显性伪影的相关因素(肠道准备方式、性别、年龄、肿瘤位置、肿瘤环周占比、直肠后系膜厚度)。结果两名独立观察者间在图像质量指标评估中具有良好一致性[组内相关系数(intra-class correlation coefficient,ICC)均>0.70]。番泻叶肠道准备组的肠内容物性质、直肠肠腔气体量、肿瘤层面气体定量评分均高于单纯限制饮食组(P均<0.05)。番泻叶肠道准备组的DWI_(b1000)和DWI_(b2000)的整体伪影和肿瘤区伪影程度均显著低于单纯限制饮食组(P均<0.05)。在相同的肠道准备方式中,DWI_(b2000)的整体伪影及肿瘤区伪影程度均显著高于DWI_(b1000)(P均<0.01)。多因素logistic回归分析表明肠道准备方式是肿瘤区DWI_(b2000)临床显性伪影的独立相关因素(OR=3.463,95%CI:1.738~6.901,P<0.001)。结论与单纯限制饮食相比,番泻叶肠道准备可以改善肠道准备质量,减少DWI的磁敏感伪影水平,提高直肠超高b值DWI_(b2000)和常规DWI_(b1000)图像质量。Objective:To investigate the effect of image quality of ultra-high b-values diffusion weighted imaging(DWI)with b=2000 s/mm^(2)(DWI_(b2000))and routine DWI with b=1000 s/mm^(2)(DWI_(b1000))by different bowel preparation(drinking folium sennae soup or dietary restrictions)in patients with rectal cancer(RC).Materials and Methods:The DWI(DWI_(b1000)and DWI_(b2000))image quality and related factors were analyzed in 203 patients with RC between the bowel preparation group with folium sennae soup and the dietary restrictions groups.The bowel preparation metrics(rectal dilatation,rectal contents,amount of gas in rectum and amount of gas around the tumor)and magnetic susceptibility artifacts(overall artifacts and artifacts of the tumor area)were independently assessed in the DWI_(b1000)and DWI_(b2000)by two radiologists.Between-group comparisons of bowel preparation metrics and DWI artifacts were calculated using Mann-Whitney U test or t-test.Subsequently,DWI_(b2000)artifact scores of less than or equal to 3 score in the tumor area was defined as clinical relevant artifacts.Univariate and multivariable logistic regression was used to assess related factors(bowel preparation methods,age,gender,tumor location,tumor circumferential percentage and thickness of posterior rectal mesentery)for DWI_(b2000)clinical relevant artifacts.Results:Inter-reader agreement was good[intra-class correlation coefficient(ICC)>0.70].The rectal contents,amount of gas in rectum and amount of gas around the tumor in the bowel preparation group with folium sennae soup were higher than those of the dietary restriction groups(P<0.05),respectively.The degree of overall artifacts and artifacts of the tumor area(DWI_(b1000)and DWI_(b2000))in the bowel preparation group with drinking folium sennae soup were significantly higher than those of the dietary restriction groups(P<0.05),respectively.In the same bowel preparation group,the degree of overall artifacts and artifacts of tumor area in DWI_(b2000)were significantly higher than those of DWI_(b1000)(P

关 键 词：直肠癌 磁共振成像 扩散加权成像 伪影 泻药 

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]