扩散加权成像预测胃腺癌淋巴结转移的价值初探

Preliminary study on the value of diffusion-weighted imaging in predicting lymph node metastasis of gastric adenocarcinoma

目的探讨扩散加权成像(DWI)预测胃腺癌淋巴结转移的价值。方法选取2012年10月~2019年5月我院术前行MRI扫描并行根治性手术的57例胃腺癌患者,测量并记录肿瘤的表观弥散系数(ADC),包括最大值(ADCmax)、平均值(ADCmean)和最小值(ADCmin)。根据术后淋巴结病理结果将患者分为无淋巴结转移组和淋巴结转移组。采用独立样本t检验比较无淋巴结转移组和淋巴结转移组间ADC值的差异,绘制受试者工作特性曲线(ROC曲线)分析ADC值预测胃腺癌淋巴结转移的效能,并确定最佳阈值。运用Logistic回归分析ADC对胃腺癌淋巴结转移的独立预测作用。结果有、无淋巴结转移的两组患者在MRI有无可疑转移淋巴结,病灶的ADCmean、ADCmin及分化程度等方面的差异均有统计学意义(P均<0.05),而肿瘤的部位、最厚径、ADCmax及Borrman分型等方面的差异无统计学意义(P均>0.05)。ADCmean和ADCmin预测胃腺癌淋巴结转移的AUC分别为:0.748、0.784。Logistic回归分析显示ADCmin是胃腺癌淋巴结转移的独立预测因子(P<0.05)。结论ADCmin可用于术前预测胃腺癌淋巴结有无转移,为临床制定个体化胃腺癌治疗方案提供参考依据。

Objective To investigate the value of diffusion-weighted imaging(DWI)in predicting gastric adenocarcinoma lymph node metastasis.Methods A retrospective analysis of 57 gastric adenocarcinoma patients with radical resection and preoperative MRI scanning of our hospital from October 2012 to May 2019 were performed.The max,mean and minimum apparent diffusion coefficient(ADCmax,ADCmin,ADCmean)values of lesion were measured for each patient.All patients were divided into two groups according to the absence or presence of lymph node metastasis of postoperative pathology.T-test was used to compare the ADC values between the two groups.The receiver operating curve(ROC)was used to evaluate the diagnostic efficacy of ADC values in differentiating lymph node metastasis of gastric adenocarcinoma,and to determine the best threshold.Logistic regression was used to analyze the independent predictive role of ADC values in lymph node metastasis of gastric adenocarcinoma.Results The suspicious metastatic lymph node on MRI,the degree of differentiation,ADCmean and ADCmin in primary lesion showed significant difference between the no lymph node metastasis and lymph node metastasis subgroups(P<0.05).However,ADCmax,tumor thickness,T staging and Borrmann classification didn't differ significantly between the two subgroups.The areas under the ADCmean and ADCmin diagnostic cure were 0.748 and 0.784 in two groups(absence and presence of lymph node metastasis)(P=0.002,<0.001 respectively).The logistic regression analysis showed that ADCmin can be used as an independent factor in predicting lymph node metastasis of gastric adenocarcinoma(P<0.05).Conclusion ADCmin of the primary lesion of gastric adenocarcinoma could help to predict lymph node metastasis before surgery.Our findings would provide more reference for clinical individual treatment.