MRI多参数预测T3-4N0期直肠癌淋巴结转移的价值

The Value of Multiparameter MRI in Predicting Lymph Node Metastasis of T3-4N0 Rectal Cancer

目的探讨多参数MRI预测直肠癌T3-4N0淋巴结转移的可行性和价值。方法回顾性分析某院2015年1月1日-2015年12月31日经手术病理证实且临床、MRI资料完整的60例T3-4N0期直肠癌患者,其中有淋巴结转移组30例,无淋巴结转移组30例。测量和记录病变位置、MRI T分期、肿瘤ADC值、病变长度及患者血清CEA。比较有、无淋巴结转移组间各参数的差异,采用ROC曲线分析有统计学意义的参数预测T3-4N0直肠癌淋巴结转移的效能。结果有、无淋巴结转移组患者间肿瘤病变位置的差异无统计学意义(P>0.05),MRI T分期、肿瘤ADC值、病变长度及患者血清CEA的差异均有统计学意义(P<0.05)。肿瘤ADC值、病变长度及患者血清CEA预测淋巴结、转移的ROC下面积分别为0.7683、0.6561、0.6961,分别以0.9965×10-3mm2/s、15.45mm、5.455为阈值,预测淋巴结转移的敏感度分别为83.33%,63.33%,73.33%,特异度分别为70%,70%,66.67%。结论直肠癌患者在多参数上,MRI T分期、肿瘤ADC值、病变长度及患者血清CEA可作为独立因素预测淋巴结转移,其中ADC值对预测直肠癌淋巴结转移作用较大。

Objective To evaluate the diagnostic value of multiparameter MRI in predicting lymph node metastasis of T3-4 N0 rectal cancer. Methods In all, 60 patients with MRI T3-4 N0 staging and histologically proven rectal carcinoma were retrospectively analyzed,from January 2015 to December 2015. There were 30 cases in metastatic and nonmetastatic lymph nodes,respectively.Lesion location,MRI T staging,tumor ADC value,lesion length and serum CEA were measured and calculated. Receiver-operating characteristic（ROC）analyses were conducted to determine the optimal thresholds. To compare the differences of the parameters between the groups with and without lymph node metastasis, and to analyze the clinical significance of the parameters of ROC curve to predict the lymph node metastasis of T3-4 N0 rectal cancer. Results There is no lymph node metastasis, tumor position difference between patients group had no statistical significance（P〉0.05）,MRI T ADC, tumor staging, lesion length and serum CEA were statistically significant（P〈0.05）. The ADC values of tumor, lesion length and serum CEA in patients with lymph node metastasis and prediction of area under ROC were 0.7683, 0.6561 and 0.6961 respectively, with0.9965×10^-3 mm^2/s, 15.45 mm, with 5.455 as the threshold to predict lymph node metastasis and the sensitivity was 83.33%, respectively, 63.33%, 73.33%, specificity was70%, 70% respectively. 66.67%. Conclusion Rectal cancer patients with multiple parameters, MRI T staging,tumor ADC, lesion length and serum CEA can be used as an independent factor to predict lymph node metastasis,and ADC value in predicting the role of colorectal cancer lymph node metastasis.