磁共振T2WI联合FOCUS DWI对直肠癌壁外血管侵犯的临床评估价值  

Clinical evaluation value of magnetic resonance T2WI combined with FOCUS DWI in extramural vascular invasion of rectal cancer

作　　者：李丹[1] 李辉 马铭婕 LI Dan;LI Hui;MA Ming-jie(Department of Magnetic Resonance Imaging,Jiaozuo People's Hospital,Jiaozuo 450000,Henan,CHINA;Cancer Center,Jiaozuo People's Hospital,Jiaozuo 450000,Henan,CHINA)

机构地区：[1]焦作市人民医院磁共振室,河南焦作450000 [2]焦作市人民医院肿瘤中心,河南焦作450000

出　　处：《海南医学》2025年第7期1019-1025,共7页Hainan Medical Journal

基　　金：河南省医学科技攻关联合共建计划项目(编号:LHGJ20191343)。

摘　　要：目的分析磁共振T2加权成像(T2WI)联合FOCUS弥散加权成像(FOCUS DWI)对直肠癌壁外血管侵犯的临床评估价值。方法回顾性分析2019年4月至2023年12月焦作市人民医院收治的75例直肠癌患者的临床资料,根据术后病理检查直肠癌壁外血管侵犯结果,将患者分为阳性组31例和阴性组44例。以术后病理结果为金标准,比较T2WI联合FOCUS DWI序列扫描对直肠癌壁外血管侵犯的诊断准确度、敏感度及特异度,采用受试者工作特征(ROC)曲线分析术前T2WI及FOCUS DWI对直肠癌壁外血管侵犯的诊断价值。结果阳性组患者的肿瘤长度、浸润深度、T3~4分期占比分别为(48.86±15.62)mm、(17.77±5.52)mm、87.10%,明显高于阴性组的(41.42±15.12)mm、(14.36±6.33)mm、54.55%,ADC值为(0.63±0.12)×10^(-3)mm^(2)/s,明显低于阴性组的(0.88±0.34)×10^(-3)mm^(2)/s,差异均有统计学意义(P<0.05),但两组患者的肿瘤部位比较差异无统计学意义(P>0.05)。术前T2WI对直肠癌壁外血管侵犯的诊断准确度为73.33%(55/75)、敏感度为70.96%(22/31)、特异度为75.00%(33/44)、阳性预测值为66.67%(22/33)、阴性预测值为78.57%(33/42)。术前FOCUS DWI对直肠癌壁外血管侵犯的诊断准确度为85.33%(64/75)、敏感度83.87%(26/31)、特异度86.36%(38/44)、阳性预测值为81.25%(26/32)、阴性预测值为88.37%(38/43)。T2WI联合FOCUS DWI对直肠癌壁外血管侵犯的诊断准确度为98.67%(74/75)、敏感度为100.00%(31/31)、特异度为97.73%(43/44)、阳性预测值为96.87%(31/32)、阴性预测值为100.00%(43/43)。ROC曲线分析结果显示,T2WI、FOCUS DWI及两者联合检查计算其曲线下面积分别为0.856、0.889、0.936,T2WI联合FOCUS DWI检查的曲线下面积大于单个检测(P<0.05)。结论T2WI和FOCUS DWI有助于术前预测直肠癌壁外血管侵犯情况,联合诊断效能更好,为临床治疗提供更准确的参考依据。Objective To analyze the clinical evaluation value of magnetic resonance T2-weighted imaging(T2WI)combined with FOCUS diffusion-weighted imaging(FOCUS DWI)in extramural vascular invasion(EMVI)of rectal cancer.Methods A retrospective analysis was conducted on the clinical data of 75 patients with rectal cancer admitted to Jiaozuo People's Hospital from April 2019 to December 2023.Based on postoperative pathological results of EMVI,patients were divided into a positive group(31 cases)and a negative group(44 cases).Using postoperative pathological results as the gold standard,the diagnostic accuracy,sensitivity,and specificity of T2WI combined with FOCUS DWI for EMVI were compared.The diagnostic value of preoperative T2WI and FOCUS DWI for EMVI was analyzed using receiver operating characteristic(ROC)curves.Results The tumor length,invasion depth,and proportion of T3-4 staging in the positive group were(48.86±15.62)cm,(17.77±5.52)mm,and 87.10%,respectively,significantly higher than(41.42±15.12)cm,(14.36±6.33)mm,and 54.55%in the negative group.The ADC value in the positive group was(0.63±0.12)×10^(-3) mm^(2)/s,significantly lower than(0.88±0.34)×10^(-3) mm^(2)/s in the negative group(P<0.05).However,there was no significant difference in tumor location between the two groups(P>0.05).The diagnostic accuracy,sensitivity,specificity,positive predictive value,and negative predictive value of preoperative T2WI for EMVI were 73.33%(55/75),70.96%(22/31),75.00%(33/44),66.67%(22/33),and 78.57%(33/42),respectively.The corresponding values for preoperative FOCUS DWI were 85.33%(64/75),83.87%(26/31),86.36%(38/44),81.25%(26/32),and 88.37%(38/43).The diagnostic accuracy,sensitivity,specificity,positive predictive value,and negative predictive value of T2WI combined with FOCUS DWI for EMVI were 98.67%(74/75),100.00%(31/31),97.73%(43/44),96.87%(31/32),and 100.00%(43/43),respectively.ROC curve analysis showed that the areas under the curve(AUC)for T2WI,FOCUS DWI,and their combination were 0.856,0.889,and 0.936,respectively.Th

关 键 词：直肠癌 磁共振 磁共振成像 弥散加权成像 壁外血管侵犯 预测价值 

分 类 号：R735.37[医药卫生—肿瘤]