摘要
目的:研究磁共振成像(MRI)中T_(2)加权成像(T_(2)WI)和弥散加权成像(DWI)序列扫描参数对直肠癌患者淋巴结转移风险的预测价值。方法:选取医院收治的164例直肠癌患者,依据患者是否发生淋巴结转移将其分为转移组(52例)和非转移组(112例)。所有患者均于手术治疗前行T_(2)WI和DWI序列扫描,获得容量转移常数(K^(trans))、速率常数(K_(ep))、血管外细胞外间隙容积比(Ve)以及表观扩散系数(ADC)值等检查参数,同时收集患者年龄、性别、体质量指数(BMI)等临床资料,以及肿瘤最大径、肿瘤类型、分化程度、T分期及术前癌胚抗原(CEA)水平等指标。比较两组患者一般资料及T_(2)WI和DWI序列检查参数,分析联合应用T_(2)WI和DWI对直肠癌患者淋巴结转移风险的预测价值。结果:非转移组患者的肿瘤低分化程度、T3、T4期患者占比显著低于转移组(χ^(2)=35.166,χ^(2)=14.752;P<0.05),K^(trans)值显著低于转移组(t=5.039,P<0.05),ADC值显著高于转移组(t=7.624,P<0.05)。经受试者工作特征(ROC)曲线分析显示,K^(trans)与ADC单独及其联合诊断参数对直肠癌患者淋巴结转移的ROC曲线下面积(AUC)分别为0.839、0.812和0.868;K^(trans)、ADC联合预测直肠癌患者淋巴结转移的诊断灵敏度为0.804,特异度为0.846,准确率为0.817,Kappa值为0.606。多因素Logistic回归分析显示,肿瘤分化程度、T分期、K^(trans)值及ADC是直肠癌患者淋巴结转移的独立影响因素(OR=1.203,OR=1.432,OR=1.342,OR=2.733;P<0.05)。结论:MRI是直肠癌患者优良的检查手段,其中T_(2)WI和DWI的扫描参数K^(trans)、ADC可作为临床预测直肠癌患者淋巴结转移的重要参考指标。
Objective:To study the predictive value of scanning parameters of T_(2)weighted imaging(T_(2)WI)and diffusion weighted imaging(DWI)sequence under magnetic resonance imaging(MRI)for the risk of lymph node metastasis of patients with rectal cancer.Methods:A total of 164 patients with rectal cancer who admitted to hospital were selected,and they were divided into metastasis group(n=52)and non-metastasis group(n=112)according to whether occurred the metastasis of lymph node.All patients underwent the scans of T_(2)WI and DWI sequence before the surgical treatment was conducted,so as to obtained a series of parameters of detection included volume transfer constant(K^(trans)),velocity constant(K_(ep)),extravascular and extracellular space volume ratio(Ve)and apparent diffusion coefficient(ADC).At the same time,the generally clinical data of patients were collected,including age,gender,body mass index(BMI),as well as the maximum diameter of tumor,the type of tumor,the degree of differentiation,the T staging and the level of the preoperative carcinoembryonic antigen(CEA).The general data and the detection parameters of T_(2)WI and DWI sequence between two groups were compared.And then,the predictive value of the combined application of T_(2)WI and DWI for the risk of lymph node metastasis of patients with rectal cancer was analyzed.Results:The degree of low differentiation of tumor of patients and the proportion of patients at T3 to T4 stage in the non-metastasis group were significantly lower than those in the metastasis group(χ^(2)=35.166,χ^(2)=14.752,P<0.05),and the K^(trans)value of the non-metastasis group was significantly lower than that of the metastasis group(t=5.039,P<0.05),and the ADC value of the former was significantly higher than that of the metastasis group(t=7.624,P<0.05),respectively.The receiver operating characteristics(ROC)curve showed that the each of the single K^(trans),the single ADC and the combination of them had a certain of predictive value for the lymph node metastasis of patients with rectal cancer,and the area under curve(AUC)of each method respectively was 0.839,0.812 and 0.868.The sensitivity,specificity,accuracy and Kappa value of the combination of K^(trans)and ADC respectively was 0.804,0.846,0.817 and 0.606 in predicting lymph node metastasis of patients with rectal cancer.The multivariate Logistic regression analysis showed that the degree of the tumor differentiation,T staging,K^(trans)and ADC respectively was the independent influencing factor of lymph node metastasis of patients with rectal cancer(OR=1.203,OR=1.432,OR=1.342,OR=2.733,P<0.05).Conclusion:MRI is an excellent examination method for patients with rectal cancer,and the K^(trans)and ADC of the scanning parameters of T_(2)WI and DWI can be used as important reference indexes for clinical prediction of lymph node metastasis of patients with rectal cancer.
作者
苏兰芳
王芳
李韩建
陈春美
万江花
刘旭东
刘丽杰
SU Lan-fang;WANG Fang;LI Han-jian(Department of Radiology,The First Affiliated Hospital of Hainan Medical University,Haikou 570102,China)
出处
《中国医学装备》
2023年第5期77-81,共5页
China Medical Equipment
基金
海南省医药卫生科研项目(1801320114A2003)“直肠癌的磁共振弥散加权成像及组织学对照研究”。
