体素内不相干运动成像鉴别诊断直肠腺瘤与腺癌的临床价值

Clinical value intravoxel incoherent motion imaging for differential diagnosis of rectal adenoma and adenocarcinoma

目的探讨体素内不相干运动(IVIM)成像鉴别诊断直肠腺瘤与腺癌的临床价值。方法选取2019年1月至2020年3月本院收治并经手术病理检查确诊的41例直肠腺癌患者,32例直肠腺瘤患者作为研究对象,均行IVIM成像检查。比较两种疾病灌注相关扩散系数(D^(*))、灌注分数(f)、真性扩散系数(D),受试者工作特征曲线(ROC),计算曲线下面积(AUC),分析诊断直肠腺癌效能。结果直肠腺瘤患者f值、D值均高于直肠腺癌患者,差异有统计学意义(P<0.05);直肠腺瘤患者D^(*)值略低于直肠腺癌患者,但差异无统计学意义。f值、D值诊断直肠腺癌AUC值分别为0.757、0.885,诊断界值分别为0.298、0.808×10^(-3) mm^(2)/s,灵敏度分别为83.23%、86.68%,特异度分别为66.67%、80.96%。IVIM成像f值、D值可鉴别直肠腺癌与腺瘤,D值诊断直肠腺癌特异度、灵敏度均高于f值(P<0.05)。结论IVIM成像对直肠腺癌与腺瘤鉴别诊断存在一定价值,可作为诊断直肠腺癌与腺瘤的MRI辅助检查技术,为医生提供可靠的影像学信息,帮助临床制定手术方案,以期改善患者预后。

Objective To investigate the clinical value of intravoxel incoherent motion(IVIM)imaging in the differential diagnosis of rectal adenoma and adenocarcinoma.Methods 41 patients with rectal adenocarcinoma and 32 patients with rectal adenoma who were admitted to our hospital from January 2019 to March 2020,and they were diagnosed by surgical and pathological examination were selected as the research subjects,and all underwent IVIM imaging examination.Compare the perfusion-related diffusion coefficient(D^(*)),perfusion fraction(f),true diffusion coefficient(D),receiver operating characteristic(ROC)curve,and calculate the area under the curve(AUC)between the two diseases to analyze the efficacy of distinguish rectal adenocarcinoma.Results The f value and D value of patients with rectal adenoma were higher than those of patients with rectal adenocarcinoma,and the difference was statistically significant(P<0.05);the D^(*)value of patients with rectal adenoma was slightly lower than that of patients with rectal adenocarcinoma,but the difference was not statistically significant.The AUC values of f value and D value for diagnosing rectal adenocarcinoma were 0.757 and 0.885.The diagnostic cut-off values were 0.298 and 0.808×10^(-3)mm^(2)/s,the sensitivity was 83.23%,86.68%,and the specificity was 66.67%and 80.96%.IVIM imaging f value and D value can distinguish rectal adenocarcinoma from adenoma,and the specificity and sensitivity of D value in distinguish rectal adenocarcinoma are higher that than f value(P<0.05).Conclusion IVIM imaging has a certain value in the differential diagnosis of rectal adenocarcinoma and adenoma.It can be used as an MRI-assisted examination technique for diagnosing rectal adenocarcinoma and adenoma,providing doctors with reliable imaging information and helping clinicians to formulate surgical plans in order to improve the prognosis of patients.