高分辨率MRI联合动态增强扫描对老年直肠癌术前T、N分期的诊断价值

Diagnostic value of high-resolution MRI combined with dynamic contrast enhancement MRI in preoperative T and N staging of elderly patient with rectal cancer

目的:探讨高分辨率MRI联合动态增强扫描对老年直肠癌术前T、N分期的诊断价值。方法:回顾性分析80例老年直肠癌患者的临床、高分辨率MRI及动态增强扫描资料,计算MRI对术前T、N分期的诊断效能,并采用Kappa检验分析高分辨率MRI联合动态增强扫描的T、N分期结果与病理结果的一致性。结果:80例患者中,下段(42.50%)、溃疡型(82.50%)、腺癌普通型(96.25%)多见。MRI的T分期诊断总准确率为83.75%,T_(1)~T_(4)期诊断准确率分别为98.75%、88.75%、85.00%、95.00%,敏感度分别为75.00%、61.54%、88.46%、90.91%,特异度分别为100.00%、94.03%、78.57%、95.65%;高分辨率MRI联合动态增强扫描的T分期与病理分期一致性很强(K=0.83,P<0.001)。N分期总准确率为53.75%,N_(0)~N_(2)期诊断准确率分别为68.75%、63.75%、75.00%,敏感度分别为54.55%、41.67%、75.00%,特异度分别为86.11%、73.21%、75.00%,高分辨率MRI联合动态增强扫描的N分期与病理分期一致性中等(K=0.44,P<0.001)。结论:高分辨率MRI联合动态增强扫描对老年直肠癌T分期诊断准确率很高,能为制订治疗方案提供理论依据,但对N分期诊断准确率还有待提高。

Objective:To investigate the diagnostic value of high-resolution MRI combined with dynamic contrast enhancement MRI(DCE-MRI)in the preoperative T and N staging of elderly patients with rectal cancer.Methods:A retrospective analysis of clinical,high-resolution MRI and DCE-MRI data from 80 elderly patients with rectal cancer was performed.The diagnostic efficacy of MRI in T and N stage was calculated,and the Kappa test was used to analyze the consistency between the results of MRI combined with DCE-MRI in each T and N stage and the pathological results.Results:Among the 80 patients,the lesions were mostly common with located in lower segment(42.50%),ulcer type(82.50%)and traditional adenocarcinoma(96.25%).The overall accuracy rate of MRI in T staging was 83.75%,and the diagnostic accuracy of T_(1),T_(2),T_(3) and T_(4) stage was 98.75%,88.75%,85.00%and 95.00%,the sensitivity was 75.00%,61.54%,88.46%and 90.91%,the specificity was 100.00%,94.03%,78.57%and 95.65%,respectively,and the diagnosis consistency was good between T staging by high-resolution MRI combined with DCE-MRI and pathological staging(K=0.83,P<0.05).The overall accuracy rate of MRI in N staging was 53.75%,the diagnostic accuracy of N0,N_(1) and N_(2) stage was 68.75%,63.75%and 75.00%,the sensitivity was 54.55%,41.67%and 75.00%,the specificity was 86.11%,73.21%and 75.00%,respectively,and the diagnosis consistency was moderate between N staging by high-resolution MRI combined with DCE-MRI and pathological staging(K=0.44,P<0.001).Conclusions:High-resolution MRI combined with DCE-MRI has high diagnostic accuracy for T staging in elderly patients with rectal cancer and can provide a theoretical basis for formulating treatment plans for elderly patients with rectal cancer.However,the diagnostic accuracy of N staging needs to be further improved.