单指数、双指数及拉伸指数模型扩散加权成像参数预测直肠癌区域淋巴结转移价值
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摘要
目的探讨直肠癌原发灶单指数、双指数及拉伸指数模型扩散加权成像参数预测区域淋巴结转移价值。方法回顾性分析41例直肠癌患者术前盆腔MRI图像,根据术后病理分为淋巴结转移和非转移两组。分别测量所有直肠癌原发灶18 b值DWI序列单指数、双指数及拉伸指数模型参数,包括标准ADC(ADC standard)、快速扩散系数(ADCfast)、慢速扩散系数(ADCslow)、灌注分数(f)、扩散分布系数(DDC)、水分子扩散异质性指数(α)。采用独立样本t检验比较各参数在转移、非转移淋巴结组的差异,采用ROC曲线评价各参数值阈值及各单一参数的预测效能。结果 41例患者中转移、非转移淋巴结组分别为27例、14例。直肠癌原发灶ADCfast、f、DDC及α在转移淋巴结与非转移组之间比较差异有统计学意义(P <0. 05)。预测区域淋巴结转移曲线下面积分别为0. 672、0. 729、0. 725及0. 690;最佳阈值分别为3. 463×10~(-3)mm~2/s、0. 477%、0. 895×10~(-3)mm~2/s和0. 898。结论双指数及拉伸指数模型参数ADCfast、f、DDC及α对直肠癌区域淋巴结转移有预测价值,应用单一参数预测区域淋巴结诊断效能为低-中等,可在诊断区域淋巴结转移中提供新的思路。
Objective To investigate the prediction value of parameters measured by single index,double exponential and tensile-density index model diffusion weighted imaging for discriminating non-metastatic from metastatic regional lymph nodes in rectal cancer. Methods Preoperative MRI data of 41 patients with rectal cancer were retrospectively analyzed.All patients were divided into two groups,regional lymph node metastasis and no regional lymph node metastasis group. DC standard,ADCfast,ADCslow,filling fraction( f),diffusion distribution coefficient( DDC) and the heterogeneity of water molecule diffusion index( alpha) from 18 b value of DWI were calculated using monoexponential,biexponential,and stretched exponential diffusion weighted imaging models. We used the sample t-test to compare all parameters between lymph node metastasis and no lymph node metastasis group. We then used the receiver-operating characteristic( ROC)curve to assess threshold value and prediction efficiency of each parameter. Results Among 41 patients,mesorectal lymph node metastasis and no mesorectal lymph node metastasis group were 27 cases and 14 cases respectively. ADCfast,f,DDC and α showed statistical difference between lymph node metastasis and non-lymph node metastasis group( P < 0. 05). The area under the ROC curve( AUC) of single parameter to predict lymph node metastasis was 0. 672,0. 729,0. 725 and 0. 690 respectively,and threshold values were 3. 463 × 10~(-3) mm~2/s,0. 477%,0. 895 × 10~(-3) mm~2/s and 0. 898 respectively. Conclusion Using single ADCfast,f,DDC and α to diagnose lymph node metastasis had low to intermediate prediction effectivity and it can provides new ideas for regional lymph node metastasis diagnosis.
Objective To investigate the prediction value of parameters measured by single index,double exponential and tensile-density index model diffusion weighted imaging for discriminating non-metastatic from metastatic regional lymph nodes in rectal cancer. Methods Preoperative MRI data of 41 patients with rectal cancer were retrospectively analyzed.All patients were divided into two groups,regional lymph node metastasis and no regional lymph node metastasis group. DC standard,ADCfast,ADCslow,filling fraction( f),diffusion distribution coefficient( DDC) and the heterogeneity of water molecule diffusion index( alpha) from 18 b value of DWI were calculated using monoexponential,biexponential,and stretched exponential diffusion weighted imaging models. We used the sample t-test to compare all parameters between lymph node metastasis and no lymph node metastasis group. We then used the receiver-operating characteristic( ROC)curve to assess threshold value and prediction efficiency of each parameter. Results Among 41 patients,mesorectal lymph node metastasis and no mesorectal lymph node metastasis group were 27 cases and 14 cases respectively. ADCfast,f,DDC and α showed statistical difference between lymph node metastasis and non-lymph node metastasis group( P < 0. 05). The area under the ROC curve( AUC) of single parameter to predict lymph node metastasis was 0. 672,0. 729,0. 725 and 0. 690 respectively,and threshold values were 3. 463 × 10~(-3) mm~2/s,0. 477%,0. 895 × 10~(-3) mm~2/s and 0. 898 respectively. Conclusion Using single ADCfast,f,DDC and α to diagnose lymph node metastasis had low to intermediate prediction effectivity and it can provides new ideas for regional lymph node metastasis diagnosis.
引文
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10 韩帅,王立峰邵楠楠,等.体素内不一致运动序列评估直肠癌术前病理分级的可行性研究[J].临床放射学杂志,2015,34:1929-1934.
11 Sumi M,Nakamura T. Head and neck tumors:assessment of perfusion? related parameters and diffusion coefficients based on the intravoxel incoherent motion model[J]. Am J Neuroradiol,2013,34:410-416.
12 韩哲.磁共振序列优化扫描及体素内不相干运动磁共振成像在直肠癌诊疗中的作用与价值[D].北京:北京协和医学院,2016.
13 Bauerle T,Seyler L,Münter M,et al. Diffusion-weighted imaging in rectal carcinoma patients without and after chemoradiotherapy:a comparative study with histology[J]. European Journal of Radiology,2013,82:444-452.
14 Sugahara T,Korogi Y,Kochi M,et al. Usefulness of diffusion-weighted MRI with echo-planar technique in the evaluation of cellularity in gliomas[J]. Journal of Magnetic Resonance Imaging,1999,9:53-60.
15 Bai Y,Lin Y,Tian J,et al. Grading of Gliomas by Using Monoexponential,Biexponential,and Stretched Exponential Diffusion-weighted MR Imaging and Diffusion Kurtosis MR Imaging[J]. Radiology,2016,278:496-504.
16 Kwee TC,Galban CJ,Tsien C,et al. Intravoxel water diffusion eterogeneity imaging of human high-grade gliomas[J]. NMR iomed,2010,23:179-187.
2 葛继元,张建,吴仪仪,等.18F-FDG PET-CT在结直肠癌术前N分期中的价值及诊断标准探讨[J].医学研究杂志,2014,43:65-69.
3 Mori N,Mugikura S,Takasawa C,et al. Peritumoral apparent diffusion coefficients for prediction of lymphovascular invasion in clinically node-negative invasive breast cancer[J]. European Radiology,2016,26:331-339.
4 King AD,Tse GM,Ahuja AT,et al. Necrosis in metastatic neck nodes:diagnostic accuracy of CT,MR imaging,and US[J]. Radiology,2004,230:720-726.
5 Zhou J,Zhan S,Zhu Q,et al. Prediction of nodal involvement in primary rectal carcinoma without invasion to pelvic structures:accuracy of preoperative CT,MR,and DWIBS assessments relative to histopathologic findings[J]. Plos One,2014,9:e92779-e92786.
6 Sun YQ,Tong T. Apparent diffusion coefficient(ADC)value:apotential imaging biomarker that reflects the biological featureof rectalcancer[J]. PLo S One,2014,9:109371-109378.
7 Cho EY,Kim SH,Yoon JH,et al. Apparent diffusion coefficient for discriminating metastatic from non-metastatic lymph nodes in primary rectal cancer[J]. Eur J Radiol,2013,82:e662-e668.
8 Heijnen LA,Lambregts DM,Mondal D,et al. Diffusion-weighted MR imaging in primary rectal cancer staging demonstrates but does not characterise lymph nodes[J]. Eur Radiol,2013,23:3354-3360.
9 Yu XP,Wen L,Hou J,et al. Discrimination between Metastatic and Nonmetastatic Mesorectal Lymph Nodes in Rectal Cancer Using Intravoxel Incoherent Motion Diffusion-weighted Magnetic Resonance Imaging[J]. Academic Radiology,2016,23:479-486.
10 韩帅,王立峰邵楠楠,等.体素内不一致运动序列评估直肠癌术前病理分级的可行性研究[J].临床放射学杂志,2015,34:1929-1934.
11 Sumi M,Nakamura T. Head and neck tumors:assessment of perfusion? related parameters and diffusion coefficients based on the intravoxel incoherent motion model[J]. Am J Neuroradiol,2013,34:410-416.
12 韩哲.磁共振序列优化扫描及体素内不相干运动磁共振成像在直肠癌诊疗中的作用与价值[D].北京:北京协和医学院,2016.
13 Bauerle T,Seyler L,Münter M,et al. Diffusion-weighted imaging in rectal carcinoma patients without and after chemoradiotherapy:a comparative study with histology[J]. European Journal of Radiology,2013,82:444-452.
14 Sugahara T,Korogi Y,Kochi M,et al. Usefulness of diffusion-weighted MRI with echo-planar technique in the evaluation of cellularity in gliomas[J]. Journal of Magnetic Resonance Imaging,1999,9:53-60.
15 Bai Y,Lin Y,Tian J,et al. Grading of Gliomas by Using Monoexponential,Biexponential,and Stretched Exponential Diffusion-weighted MR Imaging and Diffusion Kurtosis MR Imaging[J]. Radiology,2016,278:496-504.
16 Kwee TC,Galban CJ,Tsien C,et al. Intravoxel water diffusion eterogeneity imaging of human high-grade gliomas[J]. NMR iomed,2010,23:179-187.