T2WI联合Gd-DTPA增强对直肠癌壁外血管侵犯的诊断价值

Value of T2WI combined with Gd-DTPA in the diagnosis of extramural vascular invasion in rectal cancer

目的对比T2WI和T2WI联合钆喷酸葡胺(Gd-DTPA)增强检查对直肠癌壁外血管侵犯(EMVI)的诊断效能。方法选取2016年6月-2019年1月本院收治的95例直肠癌患者的影像和病理资料。运用基于磁共振单独T2WI与T2WI联合Gd-DTPA增强T1WI(T2WI+Gd)的两种5分制方案对图像进行评估。以病理作为诊断标准,运用受试者工作特征曲线(ROC)评估两种评分方案的检出效能,运用χ^2检验判断两种方法的曲线下面积(AUC)有无统计学差异。计算两种方法的准确度、敏感度、特异度并运用McNemarχ^2检验比较差异是否有统计学意义。运用加权kappa检验两种方案的一致性。结果单独T2WI与T2WI+Gd诊断EMVI的AUC(95%CI)分别为0.788(0.692-0.865)和0.875(0.791-0.934),Z值为1.988(P<0.05)。准确度、敏感度及特异度分别76.8%、65.4%、79.7%与78.9%、88.5%、73.9%,McNemar检验有统计学意义(P<0.05)。加权kappa系数为0.457(P<0.01)。结论Gd-DTPA增强作为T2WI的重要补充序列可提高对EMVI的诊断性能。

Objective To investigate the value of T2 WI c ombined with or without Gd-DTPA enhanced detecting diagnosing extramural vascular invasion(EMVI)of rectal cancer.Methods The imaging and pathological data of 95 patients with rectal cancer hospitalized in our hospital from June 2016 to January 2019 were recruited.Two kinds of 5 points scoring schemes program that T2 WI or T2 WI combined with Gd-DTPA enhanced T1 WI(T2 WI+Gd)based on MRI were used to evaluate the imaging.Pathological findings were set as the diagnosis criterion,and the receiver operating characteristic(ROC)curve was used to evaluate the efficiency of the two schemes.Z-test was used to find out the differences of areas under the curves(AUC)between the two schemes.The accuracy,sensitivity and specificity of theirs were also calculated and McNemarχ^2 test was used to detect the difference between the two methods.A weighted kappa test was used to test the consistency of the two schemes.Results The AUC(95%CI)of T2 WI and T2 WI+Gd in diagnosing EMVI was 0.788(0.692-0.865)and 0.875(0.791-0.934),respectively,Z value was 1.988(P<0.05).The accuracy,sensitivity and specificity of T2 WI were76.8%,65.4%and 79.7%,respectively.And those for T2 WI+Gd were 78.9%,88.5%and 73.9%,respectively.There were significant differences in the diagnostic accuracy,sensitivity and specificity between the two schemes(P<0.05).Weighted Kappa Coefficient was 0.457(P<0.01).Conclusions Gd-DTPA enhancement as an important complementary sequence of T2 WI could improve the diagnostic performance of EMVI.