DWI ADC值在直肠癌诊断中的应用分析

doi:10.7517/issn.1674-0475.220103

摘要/Abstract

摘要： 本研究探讨磁共振扩散加权成像（DWI）表观扩散系数（ADC）与直肠癌类型、病理分化程度的相关性及临床预测价值。采取回顾性研究方法，选取直肠癌患者105例（观察组），同时选取直肠良性病变患者50例作为对照组，比较两组病灶ADC值差异，同时分析不同临床病理、预后直肠癌患者病灶ADC值差异。结果显示：观察组病灶ADC值为明显低于对照组（P<0.05）；低分化、Dukes分期C～D期、有淋巴结外肿瘤种植、Ki-67≥14%患者ADC值明显低于中高分化、A～B期、无淋巴结外肿瘤种植和Ki-67<14%患者（P<0.05）；直肠癌病灶ADC值与Ki-67指数呈负相关（r=－0.578，P<0.05）；ADC值预测低分化、Dukes分期C～D期的ROC曲线下面积分别为0.827和0.770（P<0.05）；ADC值预测有淋巴结外肿瘤种植的ROC曲线下面积为0.620（P<0.05）；死亡患者病灶ADC值低于存活患者（P<0.05）；ADC值预测患者预后的ROC曲线下面积为0.602（P>0.05）。直肠癌病灶ADC值在预测分化程度、Dukes分期方面有一定应用价值。

关键词: 磁共振扩散加权成像, 表观扩散系数, 直肠癌, 临床病理特征, 预测价值

Abstract: This study explored the correlation and clinical predictive value of the apparent diffusion coefficient (ADC) value of diffusion weighted imaging (DWI) with the type and degree of pathological differentiation of rectal cancer. Using a retrospective study, 105 patients with rectal cancer were selected as observation group, and 50 patients with benign rectal lesions were selected as the control group. Compared the difference of ADC value between the two groups, and then analyzed the differences of ADC values in rectal cancer patients with different clinicopathological and prognosis. The results showed that, the ADC value of lesions in the observation group was significantly lower than that in the control group (P<0.05). The ADC values of patients with low differentiation, Dukes stage C-D, extranodal tumor implantation and Ki-67 ≥ 14% were significantly lower than that of patients with medium and high differentiation, stage A-B, no extranodal tumor implantation and Ki-67<14% (P<0.05). The ADC value of rectal cancer lesions was negatively correlated with Ki-67 (r=-0.578, P<0.05). ADC value predicted the areas under ROC curve of poorly differentiated and Dukes stages C-D were 0.827 and 0.770, respectively (P<0.05). ADC value predicted the area under ROC curve with extranodal tumor implantation was 0.620 (P>0.05). The ADC value of lesions in deceased patients was lower than that of surviving patients (P<0.05). The area under ROC curve of ADC value predicting prognosis was 0.602 (P>0.05). The ADC value of rectal cancer has certain application value in predicting the degree of differentiation and Dukes stage.

Key words: magnetic resonance diffusion weighted imaging, apparent diffusion coefficient, rectal cancer, clinicopathological features, predictive value[HQ]

陈倩, 张艳楠, 刘杰, 黄硕. DWI ADC值在直肠癌诊断中的应用分析[J]. 影像科学与光化学, 2022, 40(4): 789-793.

CHEN Qian, ZHANG Yannan, LIU Jie, HUANG Shuo. Application Analysis of DWI ADC Value in the Diagnosis of Rectal Cancer[J]. IMAGING SCIENCE AND PHOTOCHEMISTRY, 2022, 40(4): 789-793.

参考文献

[1] 肖琳, 欧荣册. 磁共振扩散加权成像ADC值与直肠癌分化程度及T分期的相关性分析[J]. 中国CT和MRI杂志, 2019,17(8):137-139.
[2] Yin J D, Song L R, Lu H C, et al. Prediction of different sta-ges of rectal cancer:Texture analysis based on diffusion-weighted images and apparent diffusion coefficient maps[J]. World Journal of Gastroenterology, 2020,26(17):2082-2096.
[3] 杨宏宇, 高旭, 沈秀芝, 等. 常规MRI检查及扩散加权成像在直肠癌术前评估中的应用价值[J]. 磁共振成像, 2021,12(9):65-68, 87.
[4] 柳忠美, 李彦文. 137例青年人大肠癌临床病理分析[J]. 肿瘤研究与临床, 2002,14(3):175-176.
[5] 王玉娟, 陈勇, 吕茜婷, 等. 3.0T高分辨磁共振成像在直肠癌T分期及分化程度差异分析中的应用[J]. 宁夏医科大学学报, 2019,41(3):249-253.
[6] 李伟霞, 康东杰, 鲍海华, 等. 磁共振扩散加权成像对不同病理亚型腹膜后脂肪肉瘤的诊断价值[J]. 临床放射学杂志, 2020,39(3):519-523.
[7] Caruso D, Zerunian M, de Santis D, et al. Magnetic resonance of rectal cancer response to therapy:An image quality comparison between 3.0 and 1.5 tesla[J]. BioMed Research International, 2020,2020(13):1-8.
[8] 谢玉海, 钱银锋, 刘星, 等. 3.0T MR扩散加权成像及动态增强诊断直肠癌神经脉管侵犯的价值[J]. 放射学实践, 2021,36(5):637-641.
[9] Zhao L, Liang M, Yang Y, et al. Histogram models based on intravoxel incoherent motion diffusion-weighted imaging to predict nodal staging of rectal cancer[J]. European Journal of Radiology, 2021,142(7):109869.
[10] 冯轲昕, 王翔, 王昕. 增殖细胞核抗原Ki-67及其在新辅助化疗前后的变化与乳腺癌预后的关系[J]. 癌症进展, 2019,17(13):1494-1497, 1582.
[11] 薛军, 武雪亮, 贾光辉, 等. 联合检测大肠癌中RUNX3和Ki-67表达的临床意义[J]. 实用医学杂志, 2014,30(3):422-424.
[12] 程有根, 敖炜群, 茅国群, 等. 直肠癌术前ADC值与肿瘤分化程度及Ki-67增殖指数的相关性[J]. 浙江医学, 2019,41(7):661-664.
[13] Sener R N. Diffusion MRI:Apparent diffusion coefficient (ADC) values in the normal brain and a classification of brain disorders based on ADC values[J]. Computerized Medical Imaging & Graphics, 2001,25(4):299-326.
[14] 衡海艳, 丁雪, 陈浩, 等. 3.0T磁共振扩散峰度成像在鉴别直肠黏液腺癌和普通腺癌中的价值[J]. 中华医学杂志, 2020,100(37):2919-2923.
[15] 汤琅琅, 阙开乾, 范明华, 等. 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[J]. 临床放射学杂志, 2019,38(6):1062-1067.