扩散加权成像对直肠癌患者根治术后局部复发的诊断价值
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摘要
目的研究扩散加权成像(DWI)对直肠癌患者根治术后局部复发的诊断价值。方法选取2016年3月～2018年3月于海南省人民医院(以下简称"我院")接受根治术治疗且术后局部复发的直肠癌患者60例为复发组。另取同期于我院接受根治术治疗,但术后局部无复发的直肠癌患者60例为对照组。所有患者均予以常规磁共振成像(MRI)以及DWI检查。分别比较常规MRI与DWI诊断直肠癌患者根治术后局部复发的结果,复发组与对照组的信号强度值、表观弥散系数(ADC值)、对比信噪比(CNR)水平;采用受试者工作特征曲线(ROC)分析常规MRI以及DWI在直肠癌患者根治术后局部复发中的诊断效能。结果直肠癌患者根治术后局部复发常规MRI表现为术区肠壁的不均匀增厚,呈稍长T_1、长T_2信号,DWI序列上信号显著增高,在ADC图上呈低信号;直肠癌患者根治术后局部无复发者组瘢痕组织呈轻度强化。复发组的信号强度值、CNR水平高于对照组,而ADC值低于对照组,差异有统计学意义(均P <0.05)。经ROC曲线分析,发现常规MRI诊断直肠癌患者根治术后局部复发的敏感度为92.00%,特异度为95.00%,曲线下面积(AUC)为0.731;DWI诊断直肠癌患者根治术后局部复发的敏感度为96.00%,特异度为93.00%,AUC为0.815;其中DWI的AUC高于常规MRI,但差异无统计学意义(均P> 0.05)。结论 DWI对直肠癌患者根治术后局部复发的诊断价值较高,较常规MRI具有较高的诊断效能,值得临床推广应用。
Objective To study the diagnostic value of diffusion weighted imaging(DWI) in local recurrence for patients with rectal carcinoma after radical resection. Methods A total of 60 patients with rectal carcinoma who received radical resection in Hainan General Hospital( "our hospital" for short) from March 2016 to March 2018 and had local recurrence after surgery were selected as the recurrence group. Another 60 patients with rectal carcinoma who received radical resection in our hospital at the same time without local recurrence after surgery were enrolled as the control group. All patients were examined by conventional magnetic resonance imaging(MRI) and DWI. The results of local recurrence after radical resection in rectal carcinoma patients diagnosed by conventional MRI and DWI, signal intensity value, the levels of apparent diffusion coefficient(ADC value), contrast signal to noise ratio(CNR) were compared between recurrence group and control group. The diagnostic efficacy of conventional MRI and DWI in local recurrence of rectal carcinoma patients after radical resection were calculated by receiver operator characteristic curve(ROC). Results Conventional MRI showed that the local recurrence of rectal carcinoma patients after radical resection showed uneven thickened of intestinal wall, slightly long T_1, long T_2 signal, the signal on DWI sequence increased significantly and showed low signal on ADC map, and slight enhancement of scar tissue in patients without local recurrence after radical resection. The signal intensity value and CNR level of the recurrence group were higher than that of the control group, while the ADC value was lower than that of the control group, and the differences were statistically significant(P < 0.05). ROC curve analysis showed that the sensitivity of conventional MRI in the diagnosis of local recurrence after radical resection for rectal cancer was92.00%, the specificity was 95.00%, and the area under the curve(AUC) was 0.731. The sensitivity of DWI in the diagnosis of local recurrence after rectal cancer was96.00%, specificity was 93.00%, AUC was 0.815. The AUC of DWI was higher than that of conventional MRI, but the difference was not statistically significant(P > 0.05). Conclusion DWI has higher diagnostic value for local recurrence of rectal carcinoma patients after radical resection, and has higher diagnostic efficiency than conventional MRI. It is worthy of clinical application.
Objective To study the diagnostic value of diffusion weighted imaging(DWI) in local recurrence for patients with rectal carcinoma after radical resection. Methods A total of 60 patients with rectal carcinoma who received radical resection in Hainan General Hospital( "our hospital" for short) from March 2016 to March 2018 and had local recurrence after surgery were selected as the recurrence group. Another 60 patients with rectal carcinoma who received radical resection in our hospital at the same time without local recurrence after surgery were enrolled as the control group. All patients were examined by conventional magnetic resonance imaging(MRI) and DWI. The results of local recurrence after radical resection in rectal carcinoma patients diagnosed by conventional MRI and DWI, signal intensity value, the levels of apparent diffusion coefficient(ADC value), contrast signal to noise ratio(CNR) were compared between recurrence group and control group. The diagnostic efficacy of conventional MRI and DWI in local recurrence of rectal carcinoma patients after radical resection were calculated by receiver operator characteristic curve(ROC). Results Conventional MRI showed that the local recurrence of rectal carcinoma patients after radical resection showed uneven thickened of intestinal wall, slightly long T_1, long T_2 signal, the signal on DWI sequence increased significantly and showed low signal on ADC map, and slight enhancement of scar tissue in patients without local recurrence after radical resection. The signal intensity value and CNR level of the recurrence group were higher than that of the control group, while the ADC value was lower than that of the control group, and the differences were statistically significant(P < 0.05). ROC curve analysis showed that the sensitivity of conventional MRI in the diagnosis of local recurrence after radical resection for rectal cancer was92.00%, the specificity was 95.00%, and the area under the curve(AUC) was 0.731. The sensitivity of DWI in the diagnosis of local recurrence after rectal cancer was96.00%, specificity was 93.00%, AUC was 0.815. The AUC of DWI was higher than that of conventional MRI, but the difference was not statistically significant(P > 0.05). Conclusion DWI has higher diagnostic value for local recurrence of rectal carcinoma patients after radical resection, and has higher diagnostic efficiency than conventional MRI. It is worthy of clinical application.
引文
[1]潘丽,孙国平.结直肠癌根治术后复发危险因素分层分析[J].中华肿瘤防治杂志,2018,25(4):270-274.
[2]Jeong D,Park S,Kim H,et al.RhoA is associated with invasion and poor prognosis in colorectal cancer[J].Int JOncol,2016,48(2):714-722.
[3]魏定伟.MRI检查对直肠癌术后局部复发的应用效果观察[J].影像研究与医学应用,2018,2(20):131-132.
[4]曾焕虹,傅卫,孙涛,等.腹腔镜直肠癌根治术后患者的长期生存及其影响因素[J].中华普通外科杂志,2018,33(1):25-29.
[5]孟闫凯,张雨晨,张翀达,等.对比MRI平扫、增强图像的影像组学标签对直肠癌生存期的预测价值[J].中华放射学杂志,2018,52(5):349-355.
[6]龙艳,高志霖,罗平,等.MRI检查对直肠癌术后局部复发的应用效果评价[J].影像研究与医学应用,2018,2(4):135-136.
[7]杨虎强,王康,罗斌.结直肠癌与肠道菌群及饮食构成的关系[J].实用医院临床杂志,2017,14(3):148-150.
[8]汪欣,姜勇.局部复发直肠癌的外科综合治疗进展及临床策略[J].中华胃肠外科杂志,2017,20(7):748-752.
[9]王铮,苏丹柯,赖少侣,等.MR扩散加权成像诊断直肠癌患者局部复发的应用价值[J].临床放射学杂志,2018,37(8):1334-1338.
[10]陈悦,刘放,孟庆凯,等.直肠前切除术后局部复发癌治疗方式选择及预后研究[J].中国实用外科杂志,2017,37(9):1039-1042,1056.
[11]张建新,杨钊,樊鹏,等.MRI评估局部晚期直肠癌新辅助放化疗及全直肠系膜切除术后无进展生存期的价值[J].中华肿瘤杂志,2018,40(2):121-126.
[12]王庆涛,甄劲雄,黄海洋,等.影响中低位直肠癌术后预防性肠造口回纳相关因素的研究[J].中华实验外科杂志,2018,35(4):755-757.
[13]赵勇,赵泉,郑水洁,等.钆塞酸二钠对小肝癌患者T1图像改善效果及磁共振扩散加权成像表观扩散系数值的影响分析[J].成都医学院学报,2018,13(4):460-462.
[14]沈璐,唐菲,林翌,等.磁共振扩散加权成像ADC值对局部进展期乳腺癌新辅助化疗疗效及病理反应性的评估价值[J].临床和实验医学杂志,2017,16(7):717-720.
[15]董乐丹,肖琴琴,叶琼,等.磁共振弥散加权成像对宫颈癌盆腔淋巴结转移诊断的价值[J].中国现代医生,2017,55(25):101-104.
[16]张训平,张梅舜,翟锦添,等.磁共振扩散加权成像和化学位移成像在良性与恶性椎体骨折鉴别中的应用研究[J].中国当代医药,2017,24(18):57-59.
[17]胡飞翔,童彤,彭卫军,等.弥散峰度成像评价及预测直肠癌新辅助放化疗后病理完全缓解的价值[J].肿瘤影像学,2017,26(1):49-57.
[18]刘岩.多b值DWI联合MRI动态增强扫描对诊断肝细胞癌的价值探讨[J].中国现代医生,2018,56(24):119-122,封3.
[19]宋天彬,卢洁.磁共振扩散加权成像在直肠癌新辅助放化疗中的应用价值[J].协和医学杂志,2017,8(2):106-111.
[20]韩娜娜.核磁共振成像在直肠癌术后局部复发中的诊断价值研究[J].影像研究与医学应用,2017,1(12):31-33.
[21]王琪璠,张修石,于友涛,等.常规MRI联合弥散加权成像对直肠癌T分期诊断价值[J].实用肿瘤学杂志,2015,29(5):400-403.
[22]刘艳,朱丽娜,杨爱梅,等.3.0T磁共振动态对比增强及扩散加权成像在绒毛状腺瘤和直肠癌鉴别中的应用[J].新疆医科大学学报,2016,39(12):1530-1533.
[23]王莉莉,段青,薛蕴箐,等.3.0T磁共振在直肠癌术后复发与良性病变鉴别诊断中的应用[J].中华胃肠外科杂志,2011,14(11):859-863.
[24]韦军葆,朱小东,陈龙,等.磁共振扩散加权成像和动态增强成像对结直肠癌术后局部复发诊断价值Meta分析[J].中华肿瘤防治杂志,2015,22(5):392-398.
[2]Jeong D,Park S,Kim H,et al.RhoA is associated with invasion and poor prognosis in colorectal cancer[J].Int JOncol,2016,48(2):714-722.
[3]魏定伟.MRI检查对直肠癌术后局部复发的应用效果观察[J].影像研究与医学应用,2018,2(20):131-132.
[4]曾焕虹,傅卫,孙涛,等.腹腔镜直肠癌根治术后患者的长期生存及其影响因素[J].中华普通外科杂志,2018,33(1):25-29.
[5]孟闫凯,张雨晨,张翀达,等.对比MRI平扫、增强图像的影像组学标签对直肠癌生存期的预测价值[J].中华放射学杂志,2018,52(5):349-355.
[6]龙艳,高志霖,罗平,等.MRI检查对直肠癌术后局部复发的应用效果评价[J].影像研究与医学应用,2018,2(4):135-136.
[7]杨虎强,王康,罗斌.结直肠癌与肠道菌群及饮食构成的关系[J].实用医院临床杂志,2017,14(3):148-150.
[8]汪欣,姜勇.局部复发直肠癌的外科综合治疗进展及临床策略[J].中华胃肠外科杂志,2017,20(7):748-752.
[9]王铮,苏丹柯,赖少侣,等.MR扩散加权成像诊断直肠癌患者局部复发的应用价值[J].临床放射学杂志,2018,37(8):1334-1338.
[10]陈悦,刘放,孟庆凯,等.直肠前切除术后局部复发癌治疗方式选择及预后研究[J].中国实用外科杂志,2017,37(9):1039-1042,1056.
[11]张建新,杨钊,樊鹏,等.MRI评估局部晚期直肠癌新辅助放化疗及全直肠系膜切除术后无进展生存期的价值[J].中华肿瘤杂志,2018,40(2):121-126.
[12]王庆涛,甄劲雄,黄海洋,等.影响中低位直肠癌术后预防性肠造口回纳相关因素的研究[J].中华实验外科杂志,2018,35(4):755-757.
[13]赵勇,赵泉,郑水洁,等.钆塞酸二钠对小肝癌患者T1图像改善效果及磁共振扩散加权成像表观扩散系数值的影响分析[J].成都医学院学报,2018,13(4):460-462.
[14]沈璐,唐菲,林翌,等.磁共振扩散加权成像ADC值对局部进展期乳腺癌新辅助化疗疗效及病理反应性的评估价值[J].临床和实验医学杂志,2017,16(7):717-720.
[15]董乐丹,肖琴琴,叶琼,等.磁共振弥散加权成像对宫颈癌盆腔淋巴结转移诊断的价值[J].中国现代医生,2017,55(25):101-104.
[16]张训平,张梅舜,翟锦添,等.磁共振扩散加权成像和化学位移成像在良性与恶性椎体骨折鉴别中的应用研究[J].中国当代医药,2017,24(18):57-59.
[17]胡飞翔,童彤,彭卫军,等.弥散峰度成像评价及预测直肠癌新辅助放化疗后病理完全缓解的价值[J].肿瘤影像学,2017,26(1):49-57.
[18]刘岩.多b值DWI联合MRI动态增强扫描对诊断肝细胞癌的价值探讨[J].中国现代医生,2018,56(24):119-122,封3.
[19]宋天彬,卢洁.磁共振扩散加权成像在直肠癌新辅助放化疗中的应用价值[J].协和医学杂志,2017,8(2):106-111.
[20]韩娜娜.核磁共振成像在直肠癌术后局部复发中的诊断价值研究[J].影像研究与医学应用,2017,1(12):31-33.
[21]王琪璠,张修石,于友涛,等.常规MRI联合弥散加权成像对直肠癌T分期诊断价值[J].实用肿瘤学杂志,2015,29(5):400-403.
[22]刘艳,朱丽娜,杨爱梅,等.3.0T磁共振动态对比增强及扩散加权成像在绒毛状腺瘤和直肠癌鉴别中的应用[J].新疆医科大学学报,2016,39(12):1530-1533.
[23]王莉莉,段青,薛蕴箐,等.3.0T磁共振在直肠癌术后复发与良性病变鉴别诊断中的应用[J].中华胃肠外科杂志,2011,14(11):859-863.
[24]韦军葆,朱小东,陈龙,等.磁共振扩散加权成像和动态增强成像对结直肠癌术后局部复发诊断价值Meta分析[J].中华肿瘤防治杂志,2015,22(5):392-398.