摘要
目的分析扩散加权成像(DWI)结合体素内不相干运动(IVIM)诊断直肠癌术前TN分期及预测预后的价值。方法选取2022年3月至2023年3月在承德医学院附属医院行全直肠系膜切除术治疗的150例直肠癌患者。术前均行DWI、IVIM检查,以术后病理诊断结果为“金标准”,分析DWI结合IVIM诊断直肠癌肿瘤TN分期的价值,并比较不同预后情况患者DWI结合IVIM参数[表观弥散系数(ADC)、真弥散系数(D)、假弥散系数(D∗)、灌注分数(f)]与预后的关系及预测预后的价值。结果2名放射科高年资医师(副主任级别)诊断直肠癌术前肿瘤TN分期、测量ADC值、D值、D∗值、f值的一致性组内相关系数(ICC)分别为0.932、0.952、0.949、0.966、0.960。DWI结合IVIM诊断直肠癌T分期、N分期与术后病理诊断结果的一致性Kappa值分别为0.925、0.921,准确度分别为94.67%、95.33%。预后不良患者术前ADC值、D值低于预后良好患者,f值高于预后良好患者(P<0.05)。术前低ADC值、D值和高f值均为直肠癌患者预后不良的危险因素(P<0.05)。术前ADC值、D值、f值预测直肠癌患者预后不良的曲线下面积(AUC)分别为0.791、0.768、0.837,各参数联合预测预后不良的AUC为0.926,大于各参数单独预测的AUC(P<0.05)。结论DWI结合IVIM在诊断直肠癌术前肿瘤TN分期及预测预后方面均具有较高应用价值,有助于指导临床医师制定更合理的手术方案和判断预后。
Objective To analyze the value of diffusion-weighted imaging(DWI)combined with intravoxel incoherent motion(IVIM)in the diagnosis of preoperative TN staging and predicting prognosis of rectal cancer.Methods A total of 150 patients with rectal cancer who underwent total mesenterectomy from March 2022 to March 2023 in Affiliated Hospital Of Chengde Medical University were selected.All patients underwent preoperative DWI and IVIM examination,with postoperative pathological diagnosis results serving as the"gold standard".The value of DWI-IVIM in the diagnosis of rectal cancer tumor TN staging was analyzed.DWI-IVIM parameters[apparent diffusion coefficient(ADC),true diffusion coefficient(D),false diffusion coefficient(D∗),perfusion fraction(f)]in patients with different prognosis conditions were compared,the relationship between DWI-IVIM parameters and prognosis was analyzed,as well as the value of predicting prognosis.Results The consistency intraclass correlation coefficients(ICC)of TN staging,ADC value,D value,D∗value and f value of rectal cancer diagnosed by two magnetic resonance physicians of deputy director level were 0.932,0.952,0.949,0.966 and 0.960,respectively.The consistency Kappa values of DWI-IVIM in diagnosing T staging and N staging of rectal cancer with postoperative pathological diagnosis were 0.925 and 0.921,and the accuracies were 94.67%and 95.33%,respectively.Patients with poor prognosis had lower preoperative ADC and D values and higher f values compared to those with good prognosis(P<0.05).Preoperative low ADC value,D value and high f value were risk factors for poor prognosis in patients with rectal cancer(P<0.05).The areas under the curve(AUCs)of preoperative ADC value,D value and f value in predicting poor prog-nosis of rectal cancer patients were 0.791,0.768 and 0.837,respectively.The AUC for predicting poor prognosis using a combination of these parameters was 0.926,which was greater than that predicted by each parameter alone(P<0.05).Conclusion DWI-IVIM has high application value in diagnosing preoperative tumor TN staging and predicting prognosis of rectal cancer,contributing to guide clinicians to develop more reasonable surgical plans and assess prognosis.
作者
冯涛
许双燕
刘洋洋
宋雪
曹振东
FENG Tao;XU Shuangyan;LIU Yangyang;SONG Xue;CAO Zhendong(Department of Radiology,Chengde Medical University Affiliated Hospital,Chengde 067000,Hebei,China;Department of Ultrasound,Tianjin Hospital,Tianjin 300211,China)
出处
《医学研究与战创伤救治》
北大核心
2025年第11期1155-1159,共5页
Journal of Medical Research & Combat Trauma Care
基金
河北省医学科学研究课题计划(20231368)。
