DCE-MRI定量分析联合DWI影像学检查对直肠癌术前临床分期的诊断价值

Diagnostic Value of DCE-MRI Quantitative Analysis Combined with DWI in Preoperative Clinical Staging of Rectal Cancer

目的研究磁共振动态对比增强(DCE-MRI)定量分析联合磁共振扩散加权成像(DWI)影像学检查对直肠癌术前临床分期的诊断价值。方法选择2017年3月至2019年2月我院收治的直肠癌患者65例为研究对象,分别行DCE-MRI定量分析及DCE-MRI+DWI检查,分析不同检查方法对直肠癌术前临床分期的诊断准确率,并与术后病理分期结果进行Kappa一致性检验。结果65例直肠癌患者术后病理TNM分期结果:T_(1)-T_(2)期25例,T_(3)期32例,T_(4)其8例,N_(0)期37例,N_(2)期21例,N_(3)期7例;N_(0)期DCE-MRI参数K^(trans)、K_(ep)、V_(e)值显著小于N_(1)-N_(2)期(P<0.05),T_(1)-T_(2)期K^(trans)、K_(ep)、V_(e)值显著小于T_(3)~T_(4)期(P<0.05);DCE-MRI对直肠癌T分期诊断总准确率为81.54%(53/65),T_(1)-T_(2)、T_(3)、T_(4)期准确率分别为80.00%、84.38%、75.00%,Kappa=0.689(0.45~0.74),对直肠癌N分期诊断总准确率为78.46%(53/65),N_(0)、N_(1)、N_(2)期准确率分别为81.08%、76.19%、71.43%,Kappa=0.625(0.45~0.75);DCE-MRI+DWI对直肠癌T分期诊断总准确率为92.31%(60/65),T_(1)-T_(2)、T_(3)、T_(4)期准确率分别为92.00%、93.75%、87.50%,Kappa=0.871(>0.75),对直肠癌N分期诊断总准确率为90.77%(59/65),N_(0)、N_(1)、N_(2)期准确率分别为94.59%、90.48%、83.33%,Kappa=0.835(>0.75)。结论DCE-MRI定量分析联合DWI影像学检查能有效提高直肠癌临床分期诊断准确率,且与病理分期结果一致性检验优,对直肠癌术前临床分期有良好的诊断价值。

Objective To investigate the diagnostic value of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)quantitative analysis combined with diffusion-weighted imaging(DWI)in preoperative clinical staging of rectal cancer.Methods 65 patients with rectal cancer treated in our hospital from March 2017 to February 2019 were selected.Patients received the DCE-MRI and DCEMRI+DWI,respectively.The diagnostic accuracy of different examination methods for preoperative clinical staging of rectal cancer was analyzed,and its consistency with the postoperative pathological staging results was analyzed by Kappa.Results The postoperative pathological TNM staging results of 65 patients with rectal cancer showed 25 cases at stage T_(1)-T_(2),32 cases at stage T_(3),8 cases at stage T_(4),37 cases at stage N_(0),21 cases at stage N_(2),and 7 cases at stage N_(3).K^(trans),K_(ep),and V_(e) of patients at the N_(0) stage were significantly lower than those at N_(1)-N_(2)(P<0.05).K^(trans),K_(ep),and V_(e) of patients at the T_(1)-T_(2) stage were significantly lower than those of T_(3)-T_(4)(P<0.05).The total accuracy rate of DCE-MRI in the diagnosis of rectal cancer T staging was 81.54%(53/65).The accuracy rate of DCE-MRI in the diagnosis of T_(1)-T_(2),T_(3),and T_(4) of rectal cancer was 80.00%,84.38%,and 75.00%,respectively,Kappa=0.689(0.45-0.74).The overall accuracy rate of DCE-MRI in the diagnosis of rectal cancer N staging was 78.46%(53/65),and the accuracy rate of DCE-MRI in the diagnosis of N_(0),N_(1),and N_(2) stages was 81.08%,76.19%,and 71.43%,respectively,Kappa=0.625(0.45-0.75).The total accuracy of DCE-MRI+DWI in the diagnosis of rectal cancer T staging was 92.31%(60/65),the accuracy rate of DCE-MRI+DWI in the diagnosis of T_(1)-T_(2),T_(3),and T_(4) of rectal cancer was 92.00%,93.75%,and 87.50%,respectively,Kappa=0.871(>0.75).The overall accuracy rate of DCE-MRI+DWI in the diagnosis of rectal cancer N staging was 90.77%(59/65),and the accuracy rate of DCE-MRI+DWI in the diagnosis of N_(0),N_(1),and N_(2) stages was 94.59%,90.48%,and 83.33%,respectively,Kappa=0.835(>0.75).Conclusion DCE-MRI quantitative analysis combined with DWI imaging examination can effectively improve clinical staging diagnosis of rectal cancer,which has a good consistency with the pathological staging results.