基于3.0T MRI及ADC值在鉴别直肠癌旁肿瘤沉积与转移淋巴结中的价值  

The Value of 3.0T MRI and ADC Values in Differentiating Tumor Deposits from Metastatic Lymph Nodes Adjacent to Rectal Cancer

作　　者：唐娉娉 王庆军 马贺骥 TANG Pingping;WANG Qingjun;MA Heji(The First Affiliated Hospital of Jinzhou Medical University,Jinzhou Medical University,Jinzhou,Liaoning Province 121000,P.R.China)

机构地区：[1]锦州医科大学附属第一医院放射科,121000 [2]锦州医科大学

出　　处：《临床放射学杂志》2024年第9期1539-1545,共7页Journal of Clinical Radiology

基　　金：2022年度辽宁省教育科学“十四五”规划课题(JG22DB258)。

摘　　要：目的探究表观扩散系数(ADC)和常规MRI特征是否有助于区分直肠癌旁肿瘤沉积(TD)与转移淋巴结(MLN)。方法搜集60例于2018年6月至2023年8月在术前接受过MRI检查且未经术前治疗的直肠腺癌患者的影像学资料和病理结果。经过影像与病理结果的匹配,纳入了108个病灶结节,其中40个为TD,68个为MLN。测量并计算两组结节的ADC值,包括结节ADCmean、结节ADCmin、结节ADCmax、ROI2mean、ROI2min、ROI2max、原发灶ADCmean、原发灶ADCmin、RADCmean、RADCmin;评估其常规MRI特征,包括结节大小、结节T_(2)信号、结节强化信号、血管穿过结节情况、结节形态、结节边界。采用独立样本t检验、Mann-Whitney U检验及χ^(2)检验,分析上述ADC值和常规MRI特征在TD及MLN中的差异,二元Logistic回归分析TD的独立预测因素,绘制受试者工作特征曲线(ROC)明确预测效能。结果结节ADCmin、原发灶ADCmean、RADCmean、RADCmin、短径/长径、血管穿过结节在TD与MLN组间的单因素分析中具有统计学意义(P<0.05)。常规MRI特征中结节的短径、长径、结节T_(2)信号、边界、形态以及强化在两组间没有统计学意义(P>0.05)。原发灶ADCmean(OR值=0.934)、RADCmean(OR值=1.061)、RADCmin(OR值=0.902)、血管穿过结节(OR值=4.003)在二元Logistic回归分析中有统计学意义(P<0.05)。ROC曲线分析显示原发灶ADCmean<0.895×10^(-3)mm^(2)/s时,诊断TD的AUC、敏感度、特异度分别为0.668、70%、64.7%。ADC的联合模型以及ADC结合血管穿过结节的联合模型对鉴别二者的诊断效能较单独一项变量的诊断效能好,曲线下面积(AUC)分别为0.849、0.879。结论原发灶ADCmean、RADCmean、RADCmin和血管穿过结节是鉴别TD与MLN的独立预测因素,ADC值的联合模型和ADC值结合血管穿过结节的联合模型对鉴别二者的准确性较单项指标高,对术前鉴别诊断TD与MLN具有一定价值。Objective To investigate whether apparent diffusion coefficient(ADC)and conventional MRI features are helpful in differentiating tumor deposits(TD)from metastatic lymph nodes(MLN).Methods Collection of 60 patients with a pathologically confirmed rectum adenocarcinoma from June 2018 to August 2023,who were untreated preoperatively and undergone MRI.After matching imaging and pathology results,108 nodules were included,of which 40 were TD and 68 were MLN.Measure and calculate the ADC values of the nodule.Evaluate routine MRI features of the nodules.Independent samples t-test,Mann-Whitney U-test and chi-square test were used to analyze the differences in TD and MLN nodules,binary logistic regression was used to analyze the independent predictive factors,and receiver operating characteristic curve(ROC)were plotted to clarify the diagnostic efficacy.Results Nodule ADCmin,primary-lesion ADCmean,nodule ADCmean/primary-lesion ADCmean,nodule ADCmin/primary-lesion ADCmin,short diameter/long diameter,and vessel crossing the nodule were statistically significant in a one-way analysis between TD and MLN groups(P<0.05).Primary-lesion ADCmean,nodule ADCmean/primary-lesion ADCmean,nodule ADC min/primary-lesion ADCmin,and vessels crossing the nodule were statistically significant in binary logistic regression analyses(P<0.05).ROC curve analysis showed that when the primary ADCmean was<0.895×10^(-3)mm^(2)/s,the AUC、sensitivity and specificity of TD diagnosis were 0.668、70%and 64.7%.The diagnostic efficiency of the combined model with ADC values and the combined model with ADC values combined with blood vessel passing through the nodule was better,and the area under the curve(AUC)was 0.849 and 0.879,which were greater than the diagnostic efficiency of a single variable.Conclusion The primary lesion ADC_(mean),R ADC_(mean),R ADCmin,and vascular crossing nodules are independent predictive factors for distinguishing TD from MLN.The combined model of ADC value and the combined model of ADC value and vascular crossing nodules have

关 键 词：直肠癌 肿瘤沉积 表观扩散系数 磁共振成像 转移淋巴结 

分 类 号：R735.37[医药卫生—肿瘤] R445.2[医药卫生—临床医学]