磁共振DWIBS在结直肠癌术后局部复发中的诊断价值
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摘要
目的探讨磁共振背景抑制扩散加权成像(DWIBS)在结直肠癌术后局部复发灶中的诊断价值。方法对49例结直肠癌术后并经病理证实的患者,均行常规MRI及DWIBS检查,其中有5例行MR增强检查。回避囊变坏死区,测量复发灶与邻近正常肠管在常规MRI及DWIBS中的表观弥散系数(ADC)值,信号强度(SI)及背景噪声标准差(SD),分别计算在T_1WI、T_2-STIR、DWIBS中复发灶的对比噪声比(CNR)。判断常规MRI及DWIBS联合序列在结直肠癌术后复发灶中的准确性、敏感性及特异性。结果 DWIBS对结直肠癌术后复发灶诊断的敏感性为100%,准确性为95.9%;复发组信号强度明显高于对照组(P<0.05),ADC值明显小于对照组(P<0.05);DWIBS联合序列与常规MRI序列对复发组的诊断无明显统计学差异(P>0.05)。结论 DWIBS对结直肠癌术后复发灶的监测灵敏度较高,增加DWIBS可提高诊断术后复发灶的敏感率及正确率。
Objective To explore the diagnosis value of background suppression diffusion weighted imaging( DWIBS) in assessing postoperation recurrence of colorectal cancer.Methods 49 cases of postoperation colorectal cancer confirmed by pathology underwent conventional MRI and DWIBS and 5 cases underwent gadolinium- enhanced MRI. Cystic necrosis area was avoid,the apparent diffusion coefficient( ADC) value,the signal intensity( SI) and the standard deviation of background noise( SD) of lesion and adjacent normal tissues were measured in conventional MRI and DWIBS. The averages of contrast to noise ratio( CNR) were calculated in T1_ WI,T_2-STIR and DWIBS respectively. the accuracy,sensitivity and specificity were calculated in conventional MRI and DWIBS.Results The DWIBS diagnostic accuracy rate of recurrence was 95.9%,the sensitivity was 100%.The recurrence appeared high signal on DWIBS,its signal intensity was higher than the contrast group( P<0.01),its ADC value was markedly lower than the contrast group( P<0. 05). The diagnosis of recurrence group between conventional MRI and DWIBS had no significant differences( P>0. 05).Conclusion DWIBS is sensitive in the recurrence of the postoperation of colorectal cancer,the conventional MRI with DWIBS could enhance the sensitivity and accuracy rate of the postoperation recurrence of colorectal cancer than conventional MRI alone.
Objective To explore the diagnosis value of background suppression diffusion weighted imaging( DWIBS) in assessing postoperation recurrence of colorectal cancer.Methods 49 cases of postoperation colorectal cancer confirmed by pathology underwent conventional MRI and DWIBS and 5 cases underwent gadolinium- enhanced MRI. Cystic necrosis area was avoid,the apparent diffusion coefficient( ADC) value,the signal intensity( SI) and the standard deviation of background noise( SD) of lesion and adjacent normal tissues were measured in conventional MRI and DWIBS. The averages of contrast to noise ratio( CNR) were calculated in T1_ WI,T_2-STIR and DWIBS respectively. the accuracy,sensitivity and specificity were calculated in conventional MRI and DWIBS.Results The DWIBS diagnostic accuracy rate of recurrence was 95.9%,the sensitivity was 100%.The recurrence appeared high signal on DWIBS,its signal intensity was higher than the contrast group( P<0.01),its ADC value was markedly lower than the contrast group( P<0. 05). The diagnosis of recurrence group between conventional MRI and DWIBS had no significant differences( P>0. 05).Conclusion DWIBS is sensitive in the recurrence of the postoperation of colorectal cancer,the conventional MRI with DWIBS could enhance the sensitivity and accuracy rate of the postoperation recurrence of colorectal cancer than conventional MRI alone.
引文
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[8]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.
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[10]Colosio A,Soyer P,Rousset P,et al.Value of diffusionweighted and gadolinium-enhanced MRI for the diagnosis of pelvic recurrence from colorectal cancer[J].J Magn Reson Imaging,2014,40(2):306-13.
[11]Takahara T,Imai Y,Yamashita T,et al.Diffusion weighted whole body imaging with background body signal suppression(DWIBS):technical improvement using free breathing,STIR and high resolution 3D display[J].Radiat Med,2004,22(4):275-282.
[12]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.
[13]徐芹艳,孙世杭,孙西河,等.全身磁共振背景抑制扩散成像在直肠癌术前分期中的应用价值[J].临床放射学志,2012,31(5):667-671.
[2]Lambregts DM,Maas M,Cappendijk VC,et al.Wholebody diffusion-weighted magnetic resonance imaging:current evidence in oncology and potential role in colorectal cancer staging[J].Eur J Cancer,2011,47(14):2107-2116.
[3]孙世杭,孙西河,董鹏,等.磁共振全身弥散成像对结直肠癌原发病灶筛查的价值[J].医学影像学杂志,2010,20(12):1892-1895.
[4]Lambregts DM,Cappendijk VC,Maas M,et al.Value of MRI and diffusion-weighted MRI for the diagnosis of locally recurrent rectal cancer[J].Eur Radiol,2011,21(6):1250-8.
[5]Keum MA,Lim SB,Kim SA,et al.Clinicopathologic factors affecting recurrence after curative surgery for stage I colorectal cancer[J].J Korean Soc Coloproctol,2012,28(1):49-55.
[6]徐微娜,于树鹏,辛军,等.(18)F-FDG PET-CT全身显像肠道高浓聚的临床意义分析[J].现代肿瘤医学,2013,21(10):2337-2339.
[7]Song I,Kim SH,Lee SJ,et al.Value of diffusion-weighted imaging in the detection of viable tumour after neoadjuvant chemoradiation therapy in patients with locally advanced rectal cancer:comparision with T2weighted and PET/CT imaging[J].Br J Radiol,2012,85(1013):577-586.
[8]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.
[9]曹务腾,练延帮,龚佳英,等.磁共振DWI结合标准T2WI判断直肠癌局部复发[J].中国医学影像技术,2014,30(3):416-419.
[10]Colosio A,Soyer P,Rousset P,et al.Value of diffusionweighted and gadolinium-enhanced MRI for the diagnosis of pelvic recurrence from colorectal cancer[J].J Magn Reson Imaging,2014,40(2):306-13.
[11]Takahara T,Imai Y,Yamashita T,et al.Diffusion weighted whole body imaging with background body signal suppression(DWIBS):technical improvement using free breathing,STIR and high resolution 3D display[J].Radiat Med,2004,22(4):275-282.
[12]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.
[13]徐芹艳,孙世杭,孙西河,等.全身磁共振背景抑制扩散成像在直肠癌术前分期中的应用价值[J].临床放射学志,2012,31(5):667-671.