扩散峰度成像定量参数术前预测直肠癌肿瘤出芽分级的价值  

The value of quantitative parameters of diffusion kurtosis imaging in preoperative prediction of tumor budding grade of rectal cancer

作　　者：陈安良[1,2] 谢素玲 王悦 董德硕[1] 田士峰 魏强[1] 刘爱连 CHEN Anliang;XIE Suling;WANG Yue;DONG Deshuo;TIAN Shifeng;WEI Qiang;LIU Ailian(Department of Radiology,the First Affiliated Hospital of Dalian Medical University,Dalian 116011,China;Dalian Engineering Research Center for Artificial Intelligence in Medical Imaging,Dalian 116011,China;Department of Pathology,the First Affiliated Hospital of Dalian Medical University,Dalian 116011,China)

机构地区：[1]大连医科大学附属第一医院放射科,大连116011 [2]大连市医学影像人工智能工程技术研究中心,大连116011 [3]大连医科大学附属第一医院病理科,大连116011

出　　处：《磁共振成像》2025年第2期59-64,99,共7页Chinese Journal of Magnetic Resonance Imaging

基　　金：大连医科大学附属第一医院院内基金项目(编号:2019HZ007)。

摘　　要：目的研究磁共振扩散峰度成像(diffusion kurtosis imaging,DKI)定量参数预测直肠癌肿瘤出芽(tumor budding,TB)分级的价值。材料与方法回顾性分析术前行3.0 T MR检查并经手术病理证实113例直肠腺癌患者资料,按照术后病理TB分为TB中低级别组(75例)、TB高级别组(38例)。两名观察者分别测量两组病灶扩散加权成像(diffusion weighted imaging,DWI)、DKI定量参数值,包括表观扩散系数(apparent diffusion coefficient,ADC)值、各向异性分数(fractional anisotropy,FA)值、平均扩散系数(mean diffusivity,MD)值、平均扩散峰度(mean kurtosis,MK)值。使用组内相关系数(intra-class correlation coefficient,ICC)检验两名观察者各参数值测量一致性。使用独立样本t检验或Mann-Whitney U检验分析各参数两组间差异性,并通过受试者工作特征(receiver operating characteristic,ROC)曲线评价单参数及联合参数诊断效能。使用DeLong检验比较各参数诊断效能。结果两观察者测量的各定量数据一致性良好(ICC值均>0.75)。TB中低级别组MK值为0.762±0.127,低于TB高级别组的MK值(0.962±0.120);中低级别组ADC、MD值分别为1.157(1.043,1.317)×10^(-3) mm^(2)/s、(1.377±0.265)μm^(2)/ms,皆高于高级别组[0.964(0.869,1.069)×10^(-3) mm^(2)/s、(1.114±0.135)μm^(2)/ms];参数两组间差异具有统计学意义(P<0.05)。两组间FA值差异无统计学意义。ADC、MD、MK值预测TB分级的AUC分别为0.805、0.816、0.880,敏感度分别为73.7%、92.1%、76.3%,特异度分别为78.7%、68.0%、86.7%。MK值诊断效能优于ADC及MD值,差异具有统计学意义(P<0.05)。联合参数的AUC值为0.826~0.881,与MK值的AUC值差异无统计学意义。结论DKI定量参数MK与MD值对术前无创预测直肠癌TB状态具有较好的应用价值,能够为临床对患者提供不同诊疗计划提供帮助。Objective:To investigate the value of multiple quantitative parameters of magnetic resonance diffusion kurtosis imaging(DKI)in predicting tumor budding(TB)grade of rectal cancer.Materials and Methods:Retrospective analysis of data from 113 patients with rectal adenocarcinoma who underwent preoperative 3.0 T MR examination and were confirmed by surgical pathology,including 75 patients in low-medium grade TB group and 38 patients in high grade TB group.The diffusion weighted imaging(DWI)and DKI quantitative parameter values of the lesions in two groups were recorded,including the apparent diffusion coefficient(ADC)value,fractional anisotropy(FA)value,mean diffusivity(MD)value,mean kurtosis(MK)value.The intra-class correlation coefficient(ICC)test was used to evaluate the measurement consistency of each parameter value between two observers.The independent samples t-test or Mann-Whitney U test was used to analyze the differences between the two groups of parameters,and the diagnostic performances of single parameter and combined parameters were evaluated through the receiver operating characteristic(ROC)curve.The DeLong test was used to compare the performance of each parameter.Results:The agreement between the two observers for each parameter value was good(ICC>0.75).The MK value of the low-medium grade group was 0.762±0.127,which was lower than the high grade group with the value of 0.962±0.120.The ADC and MD values of the low-medium grade groups were 1.157(1.043,1.317)×10^(-3) mm^(2)/s and(1.377±0.265)μm^(2)/ms,which were all higher than those of the high grade group with the value of 0.964(0.869,1.069)×10^(-3) mm^(2)/s and(1.114±0.135)μm^(2)/ms,respectively,the difference of each parameter was statistically significant(P<0.05).There was no statistically significant difference in FA values between the two groups.The areas under the curve(AUC)of ADC,MD and MK values in predicting TB grade were 0.805,0.816,0.880,with the sensitivities of 73.7%,92.1%,76.3%,and the specificities of 78.7%,68.0%,86.7%,respectiv

关 键 词：直肠癌 肿瘤出芽 磁共振成像 扩散峰度成像 扩散加权成像 

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]