磁共振成像与计算机断层扫描在结直肠癌分期中的前瞻性比较研究
|
摘要
目的无肿瘤侵入骨盆结构的前提下,预测原发性直肠癌患者体内淋巴结转移情况时,探究术前计算机断层扫描(CT),核磁共振(MR)成像和背景体信号抑制的加权成像(DWIBS)的准确性。方法 52例直肠癌患者术前用CT和1.5T下的磁共振相控阵线圈MRI评估。术前淋巴结分期与影像学检查(CT,MRI和DWIBS)与最终组织学结果进行比较。结果 CT,MRI和DWIBS的准确率分别为71.2%,71.2%和80.8%。DWIBS对原发性直肠癌患者的敏感性和阴性预测值的准确性高于CT和MRI。CT和MRI对淋巴结影像学和病理学的分期相当一致(Kappa值分别为0.331和0.348,P=0.01),而DWIBS相对较弱(Kappa值=0.174,P<0.05)。当以淋巴结边界信息为标准时,CT和MRI的准确性分别为71.2%和71.2%,当使用淋巴结增强图像为标准时,增强CT和MRI的准确性分别为71.2%和68.5%。结论 MRI对原发性直肠癌患者的淋巴结转移预测比CT更准确。DWIBS在鉴别小恶性淋巴结和良性淋巴结方面具有重要诊断价值。
Objective To investigate the accuracy of preoperative computed tomography(CT),magnetic resonance(MR)imaging and diffusion-weighted imaging with background body signal suppression(DWIBS)in the prediction of nodal involvement in primary rectal carcinoma patients in the absence of tumor invasion into pelvic structures.Methods Fifty-two subjects with primary rectal cancer were preoperatively assessed by CT and MRI at 1.5 T with a phasedarray coil.Preoperative lymph node staging with imaging modalities(CT,MRI,and DWIBS)were compared with the final histological findings.Results The accuracy of CT,MRI,and DWIBS were 71.2%,71.2%,and 80.8%.The accuracy of DWIBS with higher sensitivity and negative predictive value for evaluating primary rectal cancer patients was higher than that of CT and MRI.Nodal staging agreement between imaging and pathology was fairly strong for CT and MRI(Kappa value=0.331 and 0.348,P<0.01)but was relatively weaker for DWIBS(Kappa value=0.174,P<0.05).The accuracy was 71.2%and 71.2%,respectively,for CT and MRI when the lymph node border information was used as the criteria,and was 71.2% and 68.5%,respectively,for enhanced CT and MRI when the lymph node enhancement pattern was used as the criteria.Conclusion MRI is more accurate than CT in predicting nodal involvement in primary rectal carcinoma patients.DWIBS has a great diagnostic value in differentiating small malignant from benign lymph nodes.
Objective To investigate the accuracy of preoperative computed tomography(CT),magnetic resonance(MR)imaging and diffusion-weighted imaging with background body signal suppression(DWIBS)in the prediction of nodal involvement in primary rectal carcinoma patients in the absence of tumor invasion into pelvic structures.Methods Fifty-two subjects with primary rectal cancer were preoperatively assessed by CT and MRI at 1.5 T with a phasedarray coil.Preoperative lymph node staging with imaging modalities(CT,MRI,and DWIBS)were compared with the final histological findings.Results The accuracy of CT,MRI,and DWIBS were 71.2%,71.2%,and 80.8%.The accuracy of DWIBS with higher sensitivity and negative predictive value for evaluating primary rectal cancer patients was higher than that of CT and MRI.Nodal staging agreement between imaging and pathology was fairly strong for CT and MRI(Kappa value=0.331 and 0.348,P<0.01)but was relatively weaker for DWIBS(Kappa value=0.174,P<0.05).The accuracy was 71.2%and 71.2%,respectively,for CT and MRI when the lymph node border information was used as the criteria,and was 71.2% and 68.5%,respectively,for enhanced CT and MRI when the lymph node enhancement pattern was used as the criteria.Conclusion MRI is more accurate than CT in predicting nodal involvement in primary rectal carcinoma patients.DWIBS has a great diagnostic value in differentiating small malignant from benign lymph nodes.
引文
[1]Bipat S,Glas AS,Slors FJ,et al.Rectal Cancer:Local Staging and Assessment of Lymph Node Involvement with Endoluminal US,CT,and MR Imaging-A Meta-Analysis1[J].Radiology,2004,232(3):773.
[2]Lahaye MJ,Engelen SM,Kessels AG,et al.USPIO-enhanced MR imaging for nodal staging in patients with primary rectal cancer:predictive criteria1[J].Radiology,2008,246(3):804.
[3]Gersak MM,Badea R,Graur F,et al.Endoscopic ultrasound for the characterization and staging of rectal cancer.Current state of the method.Technological advances and perspectives[J].Med Ultrason,2015,17(2):227.
[4]Brown G,Richards CJ,Bourne MW,et al.Morphologic Predictors of Lymph Node Status in Rectal Cancer with Use of High-SpatialResolution MR Imaging with Histopathologic Comparison[J].Radiology,2003,227(2):371.
[5]Kwee TC,Takahara T,Ochiai R,et al.Diffusionweighted wholebody imaging with background body signal suppression(DWIBS):features and potential applications in oncology[J].European radiology,2008,18(9):1937.
[6]Hosonuma T,Tozaki M,Ichiba N,et al.Clinical usefulness of diffusion-weighted imaging using low and high b-values to detect rectal cancer[J].Magnetic Resonance in Medical Sciences,2006,5(4):173.
[7]Nasu K,Kuroki Y,Kuroki S,et al.Diffusionweighted single shot echo planar imaging of colorectal cancer using a sensitivityencoding technique[J].Japanese journal of clinical oncology,2004,34(10):620.
[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(12):3354.
[9]Viera AJ,Garrett JM.Understanding interobserver agreement:the kappa statistic[J].Fam Med,2005,37(5):360.
[10]Kaur H,Choi H,You YN,et al.MR imaging for preoperative evaluation of primary rectal cancer:practical considerations[J].Radiographics,2012,32(2):389.
[11]Katsuno H,Maeda K,Hanai T,et al.Current status of local treatment for early rectal cancer in Japan:aquestionnaire survey by the 81st Congress of the Japanese Society for Cancer of the Colon and Rectum(JSCCR)in 2014[J].Int J Clin Oncol,2018,21(2):320.
[12]Ishida H,Hatano S,Ishiguro T,et al.Prediction of Lateral Lymph Node Metastasis in Lower Rectal Cancer:Analysis of Paraffin-embedded Sections[J].Japanese journal of clinical oncology,2012,42(6):485.
[2]Lahaye MJ,Engelen SM,Kessels AG,et al.USPIO-enhanced MR imaging for nodal staging in patients with primary rectal cancer:predictive criteria1[J].Radiology,2008,246(3):804.
[3]Gersak MM,Badea R,Graur F,et al.Endoscopic ultrasound for the characterization and staging of rectal cancer.Current state of the method.Technological advances and perspectives[J].Med Ultrason,2015,17(2):227.
[4]Brown G,Richards CJ,Bourne MW,et al.Morphologic Predictors of Lymph Node Status in Rectal Cancer with Use of High-SpatialResolution MR Imaging with Histopathologic Comparison[J].Radiology,2003,227(2):371.
[5]Kwee TC,Takahara T,Ochiai R,et al.Diffusionweighted wholebody imaging with background body signal suppression(DWIBS):features and potential applications in oncology[J].European radiology,2008,18(9):1937.
[6]Hosonuma T,Tozaki M,Ichiba N,et al.Clinical usefulness of diffusion-weighted imaging using low and high b-values to detect rectal cancer[J].Magnetic Resonance in Medical Sciences,2006,5(4):173.
[7]Nasu K,Kuroki Y,Kuroki S,et al.Diffusionweighted single shot echo planar imaging of colorectal cancer using a sensitivityencoding technique[J].Japanese journal of clinical oncology,2004,34(10):620.
[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(12):3354.
[9]Viera AJ,Garrett JM.Understanding interobserver agreement:the kappa statistic[J].Fam Med,2005,37(5):360.
[10]Kaur H,Choi H,You YN,et al.MR imaging for preoperative evaluation of primary rectal cancer:practical considerations[J].Radiographics,2012,32(2):389.
[11]Katsuno H,Maeda K,Hanai T,et al.Current status of local treatment for early rectal cancer in Japan:aquestionnaire survey by the 81st Congress of the Japanese Society for Cancer of the Colon and Rectum(JSCCR)in 2014[J].Int J Clin Oncol,2018,21(2):320.
[12]Ishida H,Hatano S,Ishiguro T,et al.Prediction of Lateral Lymph Node Metastasis in Lower Rectal Cancer:Analysis of Paraffin-embedded Sections[J].Japanese journal of clinical oncology,2012,42(6):485.