DCE-MRI定量参数和ADC值评估直肠癌病理分化程度和淋巴结转移的价值  

Value of DCE-MRI quantitative parameters and ADC values in assessing the degree of histological differentiation and lymph node metastasis in rectal cancer

作　　者：张堃 左雪石 王琦 殷宝渊 王梦祥 王剑 赵源 Zhang Kun;Zuo Xueshi;WangQi;Yin Baoyuan;Wang Mengxiang;Wang Jian;Zhao Yuan(Department of Medical Imaging,Xi'an Chang'an Hospital,Xi'an 710016,China;Department of Medical Imaging,Xi'an Qinhuang Hospital,Xi'an 710043,China;Department of Medical Imaging,The Second Affiliated Hospital of Xi'an Medical University,Xi'an 710038,China)

机构地区：[1]西安长安医院医学影像科,西安710016 [2]西安秦皇医院医学影像科,西安710043 [3]西安医学院第二附属医院医学影像科,西安710038

出　　处：《保健医学研究与实践》2024年第9期50-55,共6页Health Medicine Research and Practice

基　　金：陕西省社会发展科技攻关项目(2023142)。

摘　　要：目的探讨1.5T磁共振弥散加权成像(MR-DWI)表观扩散系数(ADC)值评估直肠癌分化程度及淋巴结转移的价值,以期为直肠癌术前评估提供参考。方法收集西安长安医院2020年10月—2023年12月收治的96例直肠癌患者的临床资料,根据分化程度分为高分化组(n=21)、中分化组(n=57)、低分化组(n=18);根据淋巴结转移情况分为有淋巴结转移组(n=43)和无淋巴结转移组(n=53)。比较直肠癌不同分化程度及淋巴结转移情况患者ADC值、转运常数(Ktrans)、部分细胞外血管外间隙容量(Ve)及血液回流常数(Kep),并绘制ROC曲线分析ADC值对直肠癌分化程度的评估价值。结果低分化组患者ADC值低于高分化组和中分化组,Ktrans、Ve值高于高分化组和中分化组,差异均有统计学意义(P<0.05);不同分化程度直肠癌患者Kep值比较,差异无统计学意义(P>0.05)。有淋巴结转移组患者Ktrans值高于无淋巴结转移组,差异有统计学意义(P<0.05);无淋巴结转移组和有淋巴结转移组患者ADC、Ve及Kep值比较,差异均无统计学意义(P>0.05)。Ktrans、Ve及ADC值联合评估直肠癌分化程度的曲线下面积(AUC)、敏感度、特异度分别为0.912(95%CI:0.793~0.965)、93.84%、90.92%,高于单一指标检测(P<0.05)。结论DCE-MRI定量参数和ADC值能够在一定程度上反映直肠癌的分化程度或淋巴结转移情况,ADC、Ktrans、Ve联合检测能够提高评估直肠癌分化程度的效能,为直肠癌的术前评估提供可靠影像学依据。但ADC值在评估直肠癌是否存在淋巴结转移方面的有效性尚需在未来进一步研究和验证。Objective To explore the value of apparent diffusion coefficient(ADC)values from 1.5T magnetic resonance diffusion-weighted imaging(MR-DWI)in assessing the degree of differentiation and lymph node metastasis in rectal cancer,aiming to provide a reference for the preoperative assessment of rectal cancer.Methods Clinical data of 96 patients with rectal cancer treated at Chang'an Hospital from October 2020 to December 2023 were collected and assigned to well-differentiated(n=21),moderately differentiated(n=57),and poorly differentiated groups(n=18)based on the degree of differentiation;and to lymph node metastasis group(n=43)and non-lymph node metastasis group(n=53)based on lymph node metastasis status.The ADC values,transfer constants(Ktrans),partial extracellular vascular extravascular space volume(Ve),and blood flow return constants(Kep)of patients with different degrees of differentiation and lymph node metastasis were compared,and ROC curves were plotted to analyze the predictive value of ADC values for the differentiation degree of rectal cancer.Results The ADC values in the poorly differentiated group were lower than those in the well-differentiated and moderately differentiated groups,and the Ktrans and Ve values were higher than those in the well-differentiated and moderately differentiated groups,with statistically significant differences(P<0.05).No significant differences were noted in Kep values among patients with different degrees of differentiation(P>0.05).The Ktrans values in the lymph node metastasis group were significantly higher than those in the non-lymph node metastasis group(P<0.05).Moreover,no significant differences were found in ADC,Ve,and Kep values between the non-lymph node metastasis group and the lymph node metastasis group(P>0.05).The area under curve(AUC),sensitivity,and specificity of Ktrans,Ve,and ADC values combined in predicting the differentiation degree of rectal cancer were 0.912(95%CI:0.793-0.965),93.84%,and 90.92%,respectively,which were significantly higher than those of si

关 键 词：直肠癌 磁共振成像 弥散加权成像 表观扩散系数 分化程度 淋巴结转移 评估价值 

分 类 号：R445.2[医药卫生—影像医学与核医学]