直肠腔内三维超声和MRI对中下段直肠癌壁外血管侵犯程度的评估效果

Effects of three-dimensional transrectal ultrasound and MRI in evaluation of extramural vascular invasion degrees of middle and lower rectal cancer

目的:比较直肠腔内三维超声(3D-ERUS)和核磁共振成像(MRI)对中下段直肠癌术前壁外血管侵犯(EMVI)的诊断结果,探讨3D-ERUS在评估中下段直肠癌术前EMVI中的临床价值。方法:选取94例术后病理均诊断为直肠癌患者,术前均行3D-ERUS和MRI检查,均采用EMVI 5级评分(0~4分)进行评估。采用受试者工作特征曲线(ROC曲线)评价3D-ERUS和MRI的诊断结果,计算3D-ERUS和MRI诊断中下段直肠癌患者术前EMVI的准确率,并计算ROC曲线下面积(AUC)及特异度(Sp)、灵敏度(Se)、阳性预测值(PPV)和阴性预测值(NPV),3D-ERUS和MRI诊断结果与病理结果之间的一致性采用Kappa检验。结果:3D-ERUS诊断中下段直肠癌患者术前EMVI的准确率为90.43%(Kappa=0.685,P<0.01),AUC为0.868,Se为81.25%,Sp为92.31%,PPV为68.42%,NPV为96.00%;MRI诊断中下段直肠癌患者术前EMVI的准确率为87.23%(Kappa=0.589,P<0.01),AUC为0.824,Se为75.00%,Sp为89.74%,PPV为60.00%,NPV为94.59%。3D-ERUS和MRI诊断中下段直肠癌患者术前EMVI的准确率比较差异无统计学意义(χ^2=0.214,P=0.643),AUC比较差异也无统计学意义(Z=1.355,P=0.175)。结论:3D-ERUS和MRI在评估中下段直肠癌患者术前EMVI中具有较高的临床应用价值,3D-ERUS可作为MRI的补充用于评估术前中下段直肠癌患者的EMVI。

Objective:To compare the results of three-dimensional endorectal ultrasound(3D-ERUS)and magnetic resonance imaging(MRI)in the diagnosis of extramural vascular invasion(EMVI)of middle and lower rectal cancer before operation,and to explore the clinical value of 3D-ERUS in the evaluation of EMVI of middle and lower rectal cancer before operation.Methods:A total of 94 patients with rectal cancer confirmed by pathology were selected,and all patients were examined by 3D-ERUS and MRI.The 3D-ERUS and MRI images were evaluated with a grade 5 scores(0-4 scores)for EMVI.Receiver operating characteristic(ROC)curve was used to evaluate the results of 3D-ERUS and MRI in the diagnosis of EMVI,and the specificity(Sp),sensitivity(Se),positive predictive value(PPV),negative predictive value(NPV)accuracy,and the area under ROC curve(AUC)were calculated.Kappa test was used to evaluate the consistency between the results of 3D-ERUS and MRI in the diagnosis of EMVI and the pathological results.Results:The accuracy of 3D-ERUS in the diagnosis of EMVI was 90.43%(Kappa=0.685,P<0.01),AUC was 0.868,Se was 81.25%,Sp was 92.31%,PPV was 68.42%and NPV was 96.00%.The accuracy of MRI in the diagnosis of EMVI was 87.23%(Kappa=0.589,P<0.01),AUC was 0.824,Se was 75.00%,Sp was 89.74%,PPV was 60.00%and NPV was 94.59%.There was no statistical difference in the accuracy of diagnosis between 3D-ERUS and MRI(χ^2=0.214,P=0.643),and there was no statistical difference in the AUC of diagnosis between 3D-ERUS and MRI(Z=1.355,P=0.175).Conclusion:3D-ERUS and MRI eualuation on EMVI of the patients with middle and lower rectal cancer before operation have highly clinical values.3D-REUS can be used as a complementary tool of MRI to evaluate the EMVI of the patients with middle and lower rectal cancer before operation.