MRI动态增强序列对原发性直肠癌术前T分期的诊断价值
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摘要
目的探究动态对比增强磁共振成像(DCE-MRI)扫描对原发性直肠癌术前原发灶侵犯(T)分期的诊断效果。方法回顾性分析2017年4月—2018年3月84例原发性直肠癌患者的临床资料。以组织学检测结果为"金标准",比较术前MRI平扫及DCE-MRI对T分期诊断准确率差异,并分析组织学T分期与肿瘤区域DCE-MRI灌注参数的相关性。结果 MRI平扫对直肠癌T分期诊断总体准确率低于DCE-MRI(P<0.05)。不同组织学T分期肿瘤间转运常数(K~(trans))、速率常数(K_(ep))、容积分数(V_e)水平比较差异均有统计学意义(P<0.01)。K~(trans)、K_(ep)、V_e水平均与组织学T分期呈显著正相关(P<0.01)。结论 DCE-MRI能有效提高原发性直肠癌术前T分期准确率,肿瘤区域灌注参数与T分期的诊断关系密切。
Objective To investigate effect of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI) in diagnosis of preoperative primary tumor invasion(T) stage of patients with primary rectal cancer. Methods Clinical data of 84 patients with primary rectal cancer admitted during April 2017 and March 2018 was retrospectively analyzed. Histological test results was used as "gold standard" to compare difference in accuracy of preoperative MRI plain scan and DCE-MRI in diagnosing T-staging, and correlation between histological T-staging with DCE-MRI perfusion parameters in tumor area was analyzed. Results The overall accuracy rate of MRI plain scan in diagnosis of T staging of rectal cancer was lower than that by DCE-MRI(P<0.05). There were significant differences in transporting constant(K~(trans)), rate constant(K_(ep)) and fraction by volume(V_e) levels among tumors having different histological T stages(P<0.01). Levels of K~(trans), K_(ep) and V_e were positively correlated with histological T staging(P<0.01). Conclusion DCE-MRI may effectively improve accuracy of preoperative T-staging in patients with primary rectal cancer, and tumor regional perfusion parameters are closely related to T-staging.
Objective To investigate effect of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI) in diagnosis of preoperative primary tumor invasion(T) stage of patients with primary rectal cancer. Methods Clinical data of 84 patients with primary rectal cancer admitted during April 2017 and March 2018 was retrospectively analyzed. Histological test results was used as "gold standard" to compare difference in accuracy of preoperative MRI plain scan and DCE-MRI in diagnosing T-staging, and correlation between histological T-staging with DCE-MRI perfusion parameters in tumor area was analyzed. Results The overall accuracy rate of MRI plain scan in diagnosis of T staging of rectal cancer was lower than that by DCE-MRI(P<0.05). There were significant differences in transporting constant(K~(trans)), rate constant(K_(ep)) and fraction by volume(V_e) levels among tumors having different histological T stages(P<0.01). Levels of K~(trans), K_(ep) and V_e were positively correlated with histological T staging(P<0.01). Conclusion DCE-MRI may effectively improve accuracy of preoperative T-staging in patients with primary rectal cancer, and tumor regional perfusion parameters are closely related to T-staging.
引文
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[19] 唐翠,续晋铭,卢晓玲,等.不同病理特征直肠癌的MR灌注成像参数分析[J].中国医学影像技术,2016,32(10):1540-1544.
[20] 谢宗源,徐香玖,黄刚,等.直肠癌DCE-MRI参数与病理特征的相关性研究[J].磁共振成像,2015,6(4):289-293.
[2] 徐栋,郭盖章,许力.腹腔镜与开腹结直肠癌完整系膜切除术的短期随访研究[J].解放军医药杂志,2016,28(9):44-46,58.
[3] 邵仟仟,林国乐.2017.V1版《NCCN结直肠癌诊治指南》更新解读[J].中国全科医学,2017,20(6):635-638.
[4] 付尚志,张佳节,李万平.直肠癌术前新辅助放化疗研究进展[J].临床军医杂志,2015,43(4):409-412.
[5] 赵丽中,王宏磊.大肠癌早期诊断研究进展[J].中国肿瘤,2014,23(2):103-108.
[6] 白毓,罗鸣,张鹏.磁共振IVIM-DWI及DCE-MRI在直肠癌诊断中的应用价值[J].解放军医药杂志,2017,29(7):89-92,96.
[7] 中国抗癌协会大肠癌专业委员会.中国局部进展期直肠癌诊疗专家共识[J].中国癌症杂志,2017,27(1):41-80.
[8] 姚宏伟,吴鸿伟,刘荫华.美国癌症联合委员会第八版结直肠癌分期更新及其“预后和预测”评价体系[J].中华胃肠外科杂志,2017,20(1):24-27.
[9] 彭明,徐海荣,刘刚,等.超声内镜在结直肠癌术前精确诊断的临床价值[J].广西医学,2016,38(2):266-267,279.
[10] 李晋荣,黄文起.螺旋CT多期扫描技术在直肠癌早期诊断中的临床价值分析[J].中国CT和MRI杂志,2018,16(5):117-119,127.
[11] 万丽娟,张红梅.基于MRI的直肠癌术前评估及应用进展[J].中国医学影像技术,2017,33(10):1570-1574.
[12] 宋幸鹤,杨素行,王屹.高分辨率MRI检查诊断直肠癌淋巴结转移及分期的准确性[J].中华消化外科杂志,2017,16(8):865-873.
[13] 刘芳,周晓明,高远翔,等.直肠癌高分辨MR表现与T2、T3分期的关系[J].中国医学影像技术,2016,32(10):1531-1535.
[14] 杨心悦,肖晓娟,卢宝兰,等.DCE-MRI定量灌注参数鉴别直肠癌病理分级的Meta分析[J].中国循证医学杂志,2017,17(5):536-543.
[15] 陈勇,王爱军,郑宝军,等.MRI在直肠癌肠壁外血管侵犯评估中的应用[J].广东医学,2016,37(10):1504-1506.
[16] 唐娜,尚乃舰,张红霞.3.0T高分辨率MRI在直肠癌术前T分期中的价值[J].中国临床医学影像杂志,2016,27(8):562-564,569.
[17] 陆志华,钱伟新,曹文洪,等.磁共振扩散加权成像对直肠癌T分期的诊断价值[J].中华胃肠外科杂志,2015,18(3):257-261.
[18] 沈浮,陆建平,陈录广,等.动态增强磁共振成像在直肠癌术前诊断中的应用研究[J].中国医学计算机成像杂志,2016,22(1):39-43.
[19] 唐翠,续晋铭,卢晓玲,等.不同病理特征直肠癌的MR灌注成像参数分析[J].中国医学影像技术,2016,32(10):1540-1544.
[20] 谢宗源,徐香玖,黄刚,等.直肠癌DCE-MRI参数与病理特征的相关性研究[J].磁共振成像,2015,6(4):289-293.