动态增强MRI联合扩散加权成像与直肠癌病理分级的相关性研究
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摘要
目的探讨直肠癌动态增强磁共振成像(DCE-MRI)定量参数及扩散加权成像(DWI)与其病理分级间的相关性。方法回顾性分析52例直肠癌根治术后经病理证实的患者资料,术前均行直肠MRI检查的临床资料及影像资料。测量DCE-MRI定量参数,包括容积转运常数(K~(trans))、速率常数(K_(ep))、血管外细胞外间隙容积分数(Ve)。测量病灶的表观扩散系数(ADC)值及评估术前T分期。对手术标本进行病理分析,包括病理分级(高分化、中分化、低分化)、肿瘤大体类型(溃疡型、隆起型)和肿瘤局部浸润程度(T分期)。对各定量资料分析采用单因素方差分析。Pearson相关分析评价DCE-MRI各参数值与直肠癌病理分级的相关性,对直肠癌病理分级与MRI定量参数间的关系采用有序多分类Logistic回归分析,采用受试者工作特征(ROC)曲线评价各参数诊断直肠癌的效能。结果直肠癌MRI术前T分期与病理T分期的符合率为86.54%,Kappa值约0.761。不同组织病理分级间的DCE-MRI定量参数的差异均有统计学意义(P<0.05),且以K~(trans)值差异最为明显(P<0.01);而在ADC值上差异无统计学意义(P>0.05)。不同病理T分期间的Ve值差异有统计学意义(P<0.05),余不同病理T分期及不同肿瘤大体类型间的MRI定量及ADC值间的差异均无统计学差异(P>0.05)。K~(trans)、K_(ep)与组织病理分级呈正相关,r值分别为0.604、0.339,V_e值、ADC值与组织病理分级均呈负相关,r值分别是-0.295、-0.283,P值均<0.05。K~(trans)、K_(ep)值诊断低级别直肠癌的ROC曲线下面积(AUC)分别为0.979、0.922(P<0.01)。结论 DCE-MRI定量参数即K~(trans)、K_(ep)、V_e和ADC值与直肠癌病理分级间有一定的相关性,尤其是K~(trans)值的相关性最明显,能在一定程度反映直肠癌不同病理分级信息。
Objective To explore the correlation between dynamic contrast enhancement magnetic resonance imaging(DCE-MRI) and diffusion weighted imaging(DWI) in colorectal cancer and its pathological classification.Methods In this study,52 cases of colorectal cancer confirmed by pathological test after radical rectal cancer treatment were retrospectively analyzed.Quantitative parameters of DCE-MRI were measured,including volume transfer constant(K~(trans)),rate constant(K_(ep)),and extracellular volume ratio(V_e).The apparent diffusion coefficient(ADC) of the lesion was measured and the MRI T staging was also evaluated.Pathological analysis of surgical specimens was conducted,including pathological grading(high,medium and low differentiation),tumor gross types(ulcer type,uplift type) and tumor local infiltration degree(T) by stages.One-way ANOVA was applied to analyze the quantitative data.Pearson correlation analysis was used to evaluate the correlation between the parameters of DCE-MRI and the pathological classification of rectal cancer.The relationship between the pathological grading of rectal cancer and MRI quantitative parameters was conducted in an orderly and multi-classification Logistic regression analysis,and the efficiency of each parameter in the diagnosis of rectal cancer was evaluated by ROC curve.Results The coincidence rate between MRI preoperative T staging and pathological T staging was86.54% and the Kappa value was around 0.761.The difference of DCE-MRI quantitative parameters between different histopathological grades was statistically significant(P<0.05),and that of K~(trans)value was the most significant(P<0.01).However,there was no statistically significant difference in ADC value(P>0.05).There was statistically significance in Vevalue of different pathological T stage(P<0.05).There was no statistical difference in different pathological T stages and tumor gross type of MRI quantitative and ADC values(P>0.05).K~(trans)and K_(ep)were positively correlated with histopathological grading,with r-values being 0.604 and 0.339 respectively.Veand ADC values were negatively correlated with histopathological grading,with r values being-0.295 and-0.283 respectively,and P values were all<0.05.The ROC curve area under K~(trans)and K_(ep)were 0.979 and 0.922 respectively(P<0.01).Conclusion MRI-DCE quantitative parameters,including K~(trans),K_(ep),V_e and ADC values,exhibit a certain correlation with rectal cancer pathology classification.While K~(trans) value relevance is especially remarkable,it is able to reflect information on different pathologic classification of the rectal cancer to some extent.
Objective To explore the correlation between dynamic contrast enhancement magnetic resonance imaging(DCE-MRI) and diffusion weighted imaging(DWI) in colorectal cancer and its pathological classification.Methods In this study,52 cases of colorectal cancer confirmed by pathological test after radical rectal cancer treatment were retrospectively analyzed.Quantitative parameters of DCE-MRI were measured,including volume transfer constant(K~(trans)),rate constant(K_(ep)),and extracellular volume ratio(V_e).The apparent diffusion coefficient(ADC) of the lesion was measured and the MRI T staging was also evaluated.Pathological analysis of surgical specimens was conducted,including pathological grading(high,medium and low differentiation),tumor gross types(ulcer type,uplift type) and tumor local infiltration degree(T) by stages.One-way ANOVA was applied to analyze the quantitative data.Pearson correlation analysis was used to evaluate the correlation between the parameters of DCE-MRI and the pathological classification of rectal cancer.The relationship between the pathological grading of rectal cancer and MRI quantitative parameters was conducted in an orderly and multi-classification Logistic regression analysis,and the efficiency of each parameter in the diagnosis of rectal cancer was evaluated by ROC curve.Results The coincidence rate between MRI preoperative T staging and pathological T staging was86.54% and the Kappa value was around 0.761.The difference of DCE-MRI quantitative parameters between different histopathological grades was statistically significant(P<0.05),and that of K~(trans)value was the most significant(P<0.01).However,there was no statistically significant difference in ADC value(P>0.05).There was statistically significance in Vevalue of different pathological T stage(P<0.05).There was no statistical difference in different pathological T stages and tumor gross type of MRI quantitative and ADC values(P>0.05).K~(trans)and K_(ep)were positively correlated with histopathological grading,with r-values being 0.604 and 0.339 respectively.Veand ADC values were negatively correlated with histopathological grading,with r values being-0.295 and-0.283 respectively,and P values were all<0.05.The ROC curve area under K~(trans)and K_(ep)were 0.979 and 0.922 respectively(P<0.01).Conclusion MRI-DCE quantitative parameters,including K~(trans),K_(ep),V_e and ADC values,exhibit a certain correlation with rectal cancer pathology classification.While K~(trans) value relevance is especially remarkable,it is able to reflect information on different pathologic classification of the rectal cancer to some extent.
引文
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10何永红,林祺,詹泽娟,等.宫颈癌扩散加权成像表观扩散系数与磁共振动态增强定量参数的临床价值[J].磁共振成像,2016,7:926-931.
11 Regini F,Gourtsoyianni S,Cardoso De Melo R,et al.Rectal tumour volume(GTV)delineation using T2-weighted and diffusion-weighted MRI:Implications for radiotherapy planning[J].Eur J Radiol,2014,83:768-772.
12 Woo S,Lee JM,Yoon JH,et al.Intravoxel incoherent motion diffusion-weighted MR imaging of hepatocellular carcinoma:correlation with enhancement degree and histologic grade[J].Radiology,2014,270:758-767.
13孙应实,张晓鹏,唐磊,等.表观扩散系数值评价直肠癌术前放化疗疗效的价值[J].中华放射学杂志,2010,44:392-396.
14王铮,苏丹柯,赖少侣,等.直肠癌扩散加权成像ADC值与病理分级的相关性研究[J].临床放射学杂志,2017,36:828-832.
2卢凯,汪加亮,毛芸,等.直肠腔内超声与MRI对直肠癌术前分期评价[J].临床放射学杂志,2017,36:682-686.
3 Chikui T,Obara M,Simonetti AW,et al.The principal of dynamic contrast enhanced MRI,the method of pharmacokinetic analysis,and its application in the head and neck region[J].International J Dent,2012,2012:480659.
4 Jain RK.Normalization of tumor vasculature:an emerging concept in antiangiogenic therapy[J].Science,2005,307:58-62.
5孙冬,郭大静,赵建农.T2*-PWI联合DCE-MRI及DWI对乳腺病变的诊断价值[J].放射学实践,2016,31:501-505.
6 Tofts PS,Brix G,Buckley DL,et al.Estimating Kinetic Parameters From Dynamic Contrast-Enhanced T1-Weighted MRI of a Diffusable Tracer:Standardized Quantities and Symbols[J].J Magn Reson Imaging,1999,10:223-232.
7 van Niekerk CG,van der Laak JA,Hambrock T,et al.Correlation between dynamic contrast-enhanced MRI and quantitative histopathologic microvascular parameters in organ-cofined prostate cancer[J].Eur Radiol,2014,24:2597-2605.
8 Kim DJ,Kim JH,Lim JS,et al.Restaging of Rectal Cancer with MRImaging after Concurrent Chemotherapy and Radiation Therapy[J].Radiographics,2010,30:503-516.
9 Yeo DM,Oh SN,Jung CK,et al.Correlation of dynamic contrastenhanced MRI perfusion parameters with angiogenesis and biologic aggressiveness of rectal cancer:Preliminary results[J].J MagnReson Imaging,2015,41:474-480.
10何永红,林祺,詹泽娟,等.宫颈癌扩散加权成像表观扩散系数与磁共振动态增强定量参数的临床价值[J].磁共振成像,2016,7:926-931.
11 Regini F,Gourtsoyianni S,Cardoso De Melo R,et al.Rectal tumour volume(GTV)delineation using T2-weighted and diffusion-weighted MRI:Implications for radiotherapy planning[J].Eur J Radiol,2014,83:768-772.
12 Woo S,Lee JM,Yoon JH,et al.Intravoxel incoherent motion diffusion-weighted MR imaging of hepatocellular carcinoma:correlation with enhancement degree and histologic grade[J].Radiology,2014,270:758-767.
13孙应实,张晓鹏,唐磊,等.表观扩散系数值评价直肠癌术前放化疗疗效的价值[J].中华放射学杂志,2010,44:392-396.
14王铮,苏丹柯,赖少侣,等.直肠癌扩散加权成像ADC值与病理分级的相关性研究[J].临床放射学杂志,2017,36:828-832.