T_(3)期直肠腺癌MRI影像征象与淋巴结转移的分析

Analysis of MRI findings and lymph node metastasis in stage T3 rectal adenocarcinoma

目的通过分析T_(3)期直肠腺癌原发肿瘤MRI影像征象,探讨淋巴结转移与原发肿瘤影像征象的关系,提高对淋巴结转移诊断的准确性,指导临床选择最佳的治疗方案。方法收集2017年5月—2019年5月就诊于锦州医科大学附属第一医院且经病理证实为T_(3)期直肠腺癌的患者62例,分析其影像特征:肿瘤的位置、病变长度、病变厚度、病灶中心与腹膜反折的关系(以下简称与腹膜反折关系)、绕肠周径、表观弥散系数(ADC)值、T_(3)亚分期及淋巴结转移情况。比较有淋巴结转移与无淋巴结转移患者的影像特征的差异,并将有统计学意义的因素进行多因素Logistic回归分析。绘制受试者工作特征(ROC)曲线获得预测T_(3)期直肠腺癌发生淋巴结转移时病变厚度的临界值。结果T_(3)期直肠腺癌有淋巴结转移与无淋巴结转移患者的病变厚度和与腹膜反折关系比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析显示病变厚度是淋巴结转移的独立预测因素[OR=13.343(95%CI:2.56,69.64),P=0.002]。ROC曲线分析显示病变厚度预测T_(3)期直肠腺癌发生淋巴结转移的临界值为1.56 cm,敏感性为76.9%(95%CI:0.564,0.910),特异性为83.3%(95%CI:0.672,0.936)。结论T_(3)期直肠腺癌原发肿瘤的影像征象能一定程度地反映淋巴结的转移情况,且病变厚度是淋巴结转移的独立预测因素,可以提高对T_(3)期直肠腺癌淋巴结转移的判断,指导临床术前选择最佳的治疗方案。

Objective To study the effect of the primary tumor MRI findings of stage T3 rectal adenocarcinoma on lymph node metastasis,and to improve the accuracy of the diagnosis of lymph node metastasis to guide the clinical selection of the best treatment scheme.Methods From May 2017 to May 2019,62 patients with stage T3 rectal adenocarcinoma confirmed by pathology at the First Affiliated Hospital of Jinzhou Medical University were collected.The imaging features were analyzed as follows:the location of the tumor,lesion length and thickness,the relationship between the center of the lesion and peritoneal reflection(hereinafter referred to as relationship with peritoneal reflection),the circumference of the lesion around the intestine,apparent diffusion coefficient(ADC)value,sub-classification of T3 rectal cancer and lymph node metastasis.The differences of imaging findings between the metastatic and non-metastatic lymph nodes groups were compared.The factors with statistical significance were included in the analysis of Logistic regression equation.The receiver operating characteristic curve(ROC)was used to obtain the critical value for predicting lymph node metastasis in stage T3 rectal adenocarcinoma.Results Comparison of the lesion thickness,the relationship between the center of the lesion and peritoneal reflection between the T3 stage rectal adenocarcinoma lymph node metastasis group,and the non-metastatic group showed statistically significant differences(P<0.05).Multivariate Logistic regression analysis showed that the lesion thickness was independent predictor for lymph node metastasis[OR=13.343(95%CI:2.56,69.64)].The ROC curve showed that the critical value,sensitivity and specificity of lesion thickness for predicting lymph node metastasis in stage T3 rectal adenocarcinoma were 1.56 cm,76.9%(95%CI:0.564,0.910),and 83.3%(95%CI:0.672,0.936),respectively.Conclusions The lesion thickness in MRI findings can be used as a preliminary to judge the lymph node metastasis of stage T3 rectal adenocarcinoma.It can improve the accuracy of diagnosis of lymph node metastasis and guide the clinic to determine the best treatment before operation.