磁共振IVIM术前评估直肠癌肿瘤出芽等级的应用研究  

Application Value of Magnetic Resonance IVIM in Preoperative Evaluation of Tumor Budding of Rectal Cancer

作　　者：朱丽平 朱雨蒙 董玉莹 卓铄 孟闫凯 李绍东 ZHU Li-ping;ZHU Yu-Meng;DONG Yu-ying;ZHUO Shuo;MENG Yan-kai;LI Shao-Dong(Department of Medical Imaging,Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,Jiangsu Province,China)

机构地区：[1]徐州医科大学附属医院医学影像科,江苏徐州221002

出　　处：《中国CT和MRI杂志》2025年第2期175-177,共3页Chinese Journal of CT and MRI

摘　　要：目的探讨体素内不相干运动(IVIM)定量参数术前无创性地预测直肠癌肿瘤出芽等级的价值。方法回顾性分析2020年8月至2023年7月间于我院经手术病理证实的108例直肠腺癌患者的临床、影像学及术后病理资料。所有患者在3.0扫描仪上接受直肠常规直肠MRI和IVIM检查。一名放射科医生利用MITK-Diffusion for Philips 2019后处理工作站对图像进行后处理,在b值为1000s/mm2图像上勾画出感兴趣区域(ROI),获得直肠腺癌的表观扩散系数(apparent diffusion coefficient,ADC)、单纯扩散系数(D)、灌注相关扩散系数(D*)和灌注分数(f)值。国际肿瘤出芽共识会议依据出芽数目,将肿瘤出芽划分为1-3级,本次研究中肿瘤出芽1级为低级别TB组,2级和3级为中高级别TB组。评估各参数与术后病理TB等级的相关性,并对各参数进行ROC曲线分析,评估其预测效能,计算曲线下面积(AUC)。结果研究中的108名患者(69名男性和39名女性)的平均年龄为63.1±10.1岁。低级别TB组76例(70.4%),中高级别TB组32例(29.6%)。参数D和f与TB等级呈负相关(P<0.05)。ROC分析参数f的诊断效能最高,AUC为0.872,敏感性和特异性分别为85.7%与78.7%。结论IVIM定量参数D和f与肿瘤出芽等级具有相关性,其中灌注分数f对术前预测肿瘤出芽等级具有一定价值。Objective To investigate the value of quantitative parameters of intravoxel incoherent motion imaging(IVIM)in predicting the budding grade of rectal cancer.Methods The postoperative clinical,imaging and pathological data of 108 patients with rectal adenocarcinoma confirmed by operation and pathology in our hospital from August 2020 to July 2023 were retrospectively analyzed.All patients underwent routine rectal MRI and IVIM examinations of the rectum on a 3.0 scanner.A radiologist uses the MitK-Diffusion for Philips 2019 post-processing workstation to post-process the image,delineating the area of interest(ROI)on b=1000s/mm~2,to obtain the straight adenocarcinoma apparent diffusion(apparent diffusion coefficient,ADC)simple diffusion coefficient(D),perfusion dependent diffusion coefficient(D*),and perfusion fraction(f).According to the number of sprouts emerging,the International Consensus Conference on tumor budding divides tumor budding into grades 1-3.In this study,grade 1 tumor budding is classified as low-grade TB group,and grade 2 and 3 tumor budding is classified as medium-high grade TB group.The correlation between each parameter and postoperative pathological TB grade was evaluated,and receiver operating characteristic curve(ROC)analysis was performed for each parameter.The ROC curve was used to evaluate the predictive efficacy of the parameter,and the area under the curve(AUC)was calculated.Results The mean age of the 108 patients in the study,including 69 men and 39 women,was 63.1±10.1 years.There were 76 cases(70.4%)in the low grade TB group and 32 cases(29.6%)in the medium-high grade TB group.Parameters D and f were negatively correlated with TB grade(P<0.05).The ROC analysis of parameter f showed a good diagnostic efficiency,with an AUC of 0.872,sensitivity and specificity of 85.7%and 78.7%,respectively.Conclusion IVIM quantitative parameters D and f were correlated with tumor budding grade,among which perfusion fraction f had certain value for preoperative quantitative analysis of tumor budding gra

关 键 词：直肠腺癌 肿瘤出芽 IVIM 磁共振成像 

分 类 号：R574.63[医药卫生—消化系统] R445.2[医药卫生—内科学]