表观扩散系数鉴别诊断不同病理学特征的直肠腺癌

Apparent diffusion coefficients diagnosis of different pathological features of rectal adenocarcinoma

目的探讨ADC值鉴别不同病理学特征直肠腺癌的临床应用价值。方法回顾性分析48例经手术病理证实为直肠腺癌患者的MR资料,测量肿瘤组织的平均ADC值和最小ADC值,并比较不同术后病理学特征(肿瘤分化程度,T分期,T3期固有肌层外浸润深度,N分期,有无淋巴结外肿瘤种植,有无脉管癌栓、环周切缘是否受累)的差异;采用ROC曲线分析评价平均ADC值和最小ADC值对不同病理学特征直肠腺癌的鉴别诊断效能。结果直肠腺癌平均ADC值和最小ADC值在不同分化程度、T分期、T3期固有肌层外浸润深度和有无结外肿瘤种植差异均有统计学意义(P均<0.05);最小ADC值在不同环周切缘状态间差异有统计学意义(P=0.035),平均ADC值差异无统计学意义(P=0.180);不同N分期和有无脉管癌栓平均ADC值和最小ADC值差异均无统计学意义(P均>0.05)。平均ADC值和最小ADC值鉴别不同分化程度、T3分期、有无结外种植的直肠腺癌的ROC曲线下面积分别为0.92、0.82、0.79,0.86、0.81、0.74。结论平均ADC值、最小ADC值有助于鉴别不同病理学特征的直肠腺癌,可为术前直肠腺癌分期及评估预后提供更多的信息。

Objective To explore the application of ADC in differential diagnosis of different histopathological features of rectal adenocarcinoma. Methods The MR images of 48 patients in rectal adenocarcinoma proven pathologically were ana- lyzed restrospectively. The mean ADC （meanADC） and minimum ADC （miniADC） values were measured. ADC values were compared in different histologica grade, T-stage, N-stage, T3 extramural depths of tumor invasion, extranodal tumor deposits, lymphovascular invasion and circumferential resection margin status. ROC analysis was performed to evaluate the diagnostic performance of ADC value in different pathological features of rectal adenocarcinoma. Results The meanADC and miniADC values were both significantly different in different histological grades, T-stage, T3 extramural depths of tumor invasion and extranodal tumor deposits （all P〈0.05）. The miniADC had significant difference （P： 0. 035）, but meanADC had no significant difference （P： 0. 180） between, circumferential resection margin status. There was no significant difference of both mean ADC and miniADC between N-stage, [ymphangiovascular invasion （all P〉0.05）. The area under ROC curve of meanADC and miniADC of different histological grades, T3-stage, extranodal tumor deposits were 0.92, 0.82, 0.79 and 0.86, 0.81, 0. 74, restrospectively. Conclusion MeanADC and miniADC have clinical application vaules in diagnosis of different pathological features in rectal adenocarcinoma, which may be useful for providing additional information in the preoperative assessment of prognosis for rectal adenocarcinoma.