高分辨率MRI上淋巴结形态学特征对诊断直肠癌淋巴结转移的增益价值

Incremental value of morphologic features on high-resolution MRI in the diagnosis of lymph node metastasis of rectal cancer

目的:探讨高分辨率磁共振成像(magnetic resonance imaging,MRI)上形态学特征对诊断直肠癌淋巴结转移的增益价值。方法:回顾并分析2016年6月—2020年12月直肠癌根治术前行高分辨率MRI的直肠癌患者155例[男性99例,女性56例;平均年龄(65.06±10.17)岁],以术后病理学检查结果为“金标准”,分别计算以短径≥5 mm、短径≥9 mm、尺寸结合形态学特征3个标准判断直肠癌患者有无淋巴结转移的效能,分析形态学特征对诊断直肠癌淋巴结转移的增益价值。采用χ^(2)检验分析数据。结果:术后病理学检查结果显示60例患者存在淋巴结转移。短径≥5 mm诊断淋巴结转移的灵敏度、特异度、准确度分别为55.00%(33/60)、77.89%(74/95)、69.03%(107/155),短径≥9 mm诊断淋巴结转移的灵敏度、特异度、准确度分别为15.00%(9/60)、95.79%(91/95)、64.52%(100/155),尺寸结合形态学特征后灵敏度、准确度分别提高至73.33%(相较于短径≥5 mm、短径≥9 mm标准,χ^(2)分别为4.385和41.397,P分别为0.036和0.000)、79.35%(相较于短径≥5 mm、短径≥9 mm标准,χ^(2)分别为4.179和8.453,P分别为0.041和0.004),特异度为83.16%(79/95),相对于短径≥5 mm标准特异度差异无统计学意义(χ^(2)=0.839,P=0.360),相对于短径≥9 mm标准特异度降低(χ^(2)=8.047,P=0.005)。结合形态学特征后分别纠正短径≥5 mm、短径≥9 mm标准漏诊的淋巴结转移患者11例、35例。结论:高分辨率MRI上淋巴结尺寸结合形态学特征可显著提高诊断直肠癌淋巴结转移的灵敏度、准确度,有助于纠正尺寸标准的漏诊患者。

Objective: To investigate the incremental value of morphologic features on high-resolution magnetic resonance imaging(MRI) in the diagnosis of lymph node metastasis of rectal cancer. Methods: A total of 155 rectal cancer patients who underwent high-resolution MRI examination before radical resection from June 2016 to December 2020 [99 males and 56 females;average age(65.06±10.17) years] were retrospectively enrolled. Based on postoperative pathological results as the “gold standard”, the value of short diameter≥5 mm, short diameter≥9 mm, size combined with morphological features in the diagnosis of lymph node metastasis of rectal cancer was calculated and compared. χ^(2) test was used for data analysis. Results: Postoperative pathological results showed that 60 patients had lymph node metastasis. The sensitivity, specificity and accuracy of the diagnosis of lymph node metastasis with the criteria of short diameter≥5 mm are 55.00%(33/60), 77.89%(74/95), 69.03%(107/155), and 15.00%(9/60), 95.79%(91/95), 64.52%(107/155) for short diameter≥9 mm. Combined with morphological features, the sensitivity and accuracy were increased to 73.33%(compared with the standard of short diameter≥5 mm and short diameter≥9 mm, χ^(2)=4.385and 41.397, P=0.036 and 0.000), 79.35%(compared with the standard of short diameter≥5 mm and short diameter≥9 mm, χ^(2)=4.179and 8.453, P=0.041 and 0.004). While the specificity is 83.16%(79/95), which is no statistical difference with the 5 mm criteria(χ^(2)=0.839, P=0.360), and is reduced with the 9 mm criteria(χ^(2)=8.047, P=0.005). 11 and 35 cases of lymph node metastasis that were missed by the diameter ≥5 mm and diameter ≥9 mm criteria were corrected by combining the morphological features respectively.Conclusion: Combining size and the morphological features of lymph nodes on high-resolution MRI can significantly improve the sensitivity and accuracy of diagnosing lymph node metastasis in rectal cancer, and help a lot to correct missed cases of size criteria.