全瘤ADC直方图参数联合影像生物标志物预测直肠腺癌神经脉管浸润的价值  

The value of combining whole-tumor ADC histogram parameters with imaging biomarkers in predicting perineural and lymphovascular invasion in rectal adenocarcinoma

作　　者：王海升 袁隆 朱凯博 席华泽 刘建强[1] 雒攀 高榕 周俊林[1] 刘宏[1] WANG Haisheng;YUAN Long;ZHU Kaibo;XI Huaze;LIU Jianqiang;LUO Pan;GAO Rong;ZHOU Junlin;LIU Hong(Department of Radiology,Lanzhou University Second Hospital,Lanzhou 730030,China)

机构地区：[1]兰州大学第二医院放射科,兰州730030

出　　处：《磁共振成像》2025年第3期63-69,95,共8页Chinese Journal of Magnetic Resonance Imaging

基　　金：国家自然科学基金项目(编号:82260361);兰州大学第二医院“萃英科技创新计划”应用基础研究项目-青年项目(编号:CY2022-QN-A10)。

摘　　要：目的 探究基于全肿瘤表观扩散系数(apparent diffusion coefficient,ADC)直方图参数联合影像生物标志物预测直肠腺癌神经脉管浸润的价值。材料与方法 回顾性分析经病理证实为直肠腺癌的102例患者的术前临床及MRI资料,根据病理结果进行分组,神经侵犯(perineural invasion,PNI)和脉管侵犯(lymphovascular invasion,LVI)中任意一项或两项阳性为PNI/LVI阳性组,两项均阴性为PNI/LVI阴性组。采用FireVoxel软件勾画感兴趣区(region of interest,ROI)后获得原发肿瘤的ADC直方图参数:ADC平均值(ADC-mean)、标准差、变异系数、熵、偏度和ADC第1、5、10、25、50、75、90、95、99百分位数(ADC-1%、ADC-5%、ADC-10%、ADC-25%、ADC-50%、ADC-75%、ADC-90%、ADC-95%、ADC-99%)。分析比较PNI/LVI阳性组和阴性组间ADC直方图参数、MRI评估壁外血管侵犯(MRI assessment extramural venous invasion,mrEMVI)状态、肿瘤位置、mrT分期、mrN分期之间的差异,通过单变量分析筛选出组间差异有统计学意义(P<0.05)的ADC直方图参数,并基于这些参数构建多因素logistic回归模型(ADC直方图模型);进一步联合单变量分析中差异有统计学意义(P<0.05)的非直方图参数进行多因素logistic回归,建立联合预测模型。利用受试者工作特征(receiver operating characteristic,ROC)曲线分析ADC直方图模型和联合模型的预测效能。采用De Long检验比较各模型间曲线下面积(area under the curve,AUC)的差异。结果 ADC-mean、标准差、ADC-1%、ADC-75%、ADC-95%、ADC-99%、mrEMVI在直肠腺癌PNI/LVI阳性组和阴性组之间差异有统计学意义(P<0.05),在连续变量中,ADC-99%效能最高(AUC、敏感度、特异度分别为0.835、77.1%、86.6%)。由ADC-mean、标准差、ADC-1%、ADC-75%、ADC-95%、ADC-99%、mrEMVI构建的联合模型的AUC、敏感度、特异度分别为0.918、89.6%、82.9%,其诊断效能优于直方图模型(AUC为0.898)及各全肿瘤ADC直方图参数(AUC为0.670~0.835)。联合�Objective:To explore the value of combining whole-tumor apparent diffusion coefficient(ADC) histogram parameters with imaging biomarkers in predicting perineural invasion(PNI) and lymphovascular invasion(LVI) in rectal adenocarcinoma.Materials and Methods:A retrospective analysis was conducted on the preoperative clinical and magnetic resonance imaging(MRI) data of 102patients with pathologically confirmed rectal adenocarcinoma.Based on pathological results,patients were divided into two groups:the PNI/LVI-positive group(with either or both PNI and LVI positive) and the PNI/LVI-negative group(both PNI and LVI negative).Using FireVoxel software,regions of interest(ROIs) were delineated to obtain ADC histogram parameters of the primary tumor,including ADC mean(ADC-mean),standard deviation,coefficient of variation,entropy,skewness,and the 1st,5th,10th,25th,50th,75th,90th,95th,and 99th percentiles of ADC(ADC-1%,ADC-5%,ADC-10%,ADC-25%,ADC-50%,ADC-75%,ADC-90%,ADC-95%,ADC-99%).Differences in ADC histogram parameters,MRI assessment extramural venous invasion(mrEMVI) status,tumor location,mrT stage,and mrN stage between the PNI/LVI-positive and negative groups were analyzed.Parameters with statistically significant differences(P <0.05) were selected through univariate analysis and used to construct a multivariate logistic regression model(ADC histogram model).Additionally,non-histogram parameters that were also statistically significant(P < 0.05) in univariate analysis were included in a multivariate logistic regression analysis to establish a combined predictive model.The predictive performance of the ADC histogram model and the combined model was evaluated using receiver operating characteristic(ROC) curve analysis,and the DeLong test was used to compare the differences in the area under the curve(AUC) between the models.Results:Significant differences were observed between the PNI/LVI-positive and negative groups in ADC-mean,standard deviation,ADC-1%,ADC-75%,ADC-95%,ADC-99%,and mr EMVI(P < 0.05).Among these continuous

关 键 词：直肠腺癌 神经脉管浸润 磁共振成像 表面扩散系数 直方图 影像生物标志物 

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]