MRI在直肠癌术前分期及ADC值在直肠癌预后评价中的应用

Diagnosis in staging rectal cancer by using MRI and the ADC value assessing the prognosis in rectal cancer

目的探讨MRI在直肠癌术前分期及ADC值在直肠癌预后评价中的应用价值。方法回顾2017年9月~2019年4月我院收治的35例术前未行新辅助治疗且术后病理证实为直肠癌的患者以及15例健康志愿者的术前MRI资料,对35例直肠癌患者的MRI T分期结果与术后病理结果比较,并分析不同病理类型、分化程度、T分期、EMVI性质及CEA水平的直肠癌之间ADC值的差异。结果MRI对T分期的总准确率为68.6%,对T1~T2、T3、T4期的诊断准确率分别为54.5%、77.3%、50%,MRI术前T分期与术后病理学T分期一致性较好(P<0.05)。ADC值在健康人群与直肠癌人群、不同分化程度直肠癌组间的差异具有统计学意义(P<0.05)。ADC值在黏液腺癌与非黏液腺癌、T分期、EMVI及CEA组间的差异没有统计学意义(P>0.05)。结论3.0T MRI可以作为有效预测直肠癌T分期的无创性检查方式。ADC值随着直肠癌恶性程度升高而呈下降趋势,其可以作为预测直肠癌良恶性程度的重要指标。

Objective To assess the accuracy of MRI evaluating T stage in rectal cancer,in the meanwhile analyze the relationship between tumoral apparent diffusion coefficient(ADC)value and aggressive factors.Methods The clinical data of 35 patients not undergoing preoperative chemoradiation with postoperative pathologically proven rectal cancer and 15 healthy people from September 2017 to April 2019 were retrospectively analyzed.The results of 35 patients between preoperative MRI assessing T staging and postoperative pathological TN stage were compared.Analyse the differences of ADC values among pathological type,differentiation,T staging,EMVI and CEA level groups.Results The accuracy of preoperative MRI T,T1~T2,T3,T4 staging were 68.6%,54.5%,77.3%,50%,respectively.There was statistical significance between preoperative MRI T staging and postoperative pathological T staging(P<0.05).The ADC values between rectum of healthy people and different differentiated rectal cancer had significant difference.The ADC values between adenocarcinoma and mucinous adenocarcinoma,T staging,EMVI and CEA groups had no statistical significance.Conclusion3.0 T MRI could be an effective noninvasive examination predicting T staging.ADC values decrease as the grade malignancy increase,so it can be an important indicator of grade malignancy in rectal cancer.