高分辨磁共振成像对直肠癌壁外血管侵犯的价值分析

The Value of High-resolution Magnetic Resonance Imaging for Extramural Vascular Invasion of Rectal Cancer

目的探讨高分辨核磁共振成像对直肠癌壁外血管侵犯(EMVI)的评估诊断价值。方法回顾性收集经手术病理证实的54例直肠癌患者的磁共振及病理学资料,以术后病理结果作为诊断标准与应用高分辨MRI评估直肠癌EMVI情况进行对照。计算MRI评估EMVI的诊断准确性、灵敏性、特异性、阳性预测值和阴性预测值。采用Kappa一致性检验分析评价高分辨磁共振的诊断效能。结果54例患者中,MRI评估EMVI阳性24例,EMVI阴性30例,手术病理结果显示EMVI阳性20例,EMVI阴性34例。MRI评估EMVI诊断符合率77.8%(42/54),诊断的敏感性80%(16/20),特异性76.5%(26/34),阳性预测值66.7%(16/24),阴性预测值86.7%(26/30)。MRI评估与病理结果对直肠癌EMVI的诊断一致性中等,Kappa值=0.542(P<0.001)。结论高分辨磁共振成像在评估直肠癌壁外血管侵犯方面诊断结果准确可靠,有助于指导临床医师制定适当的个体化治疗策略。

Objective In this study,we explored the diagnostic value of high-resolution magnetic resonance imaging in evaluating extramural vascular invasion of rectal cancer.Methods The magnetic resonance and pathological data of 54 patients with rectal cancer confirmed by surgery and pathology were retrospectively collected,and the results of surgery and pathology were used as the diagnostic criteria to compare with the use of highresolution MRI to evaluate the EMVI of rectal cancer.The diagnostic accuracy,sensitivity,specificity,positive predictive value,and negative predictive value of MRI to assess EMVI were calculated.The diagnostic performance of high-resolution magnetic resonance imaging was evaluated by Kappa consistency test.Results Among the 54 patients,24 cases were positive for EMVI and 30 cases were negative for EMVI by MRI,and 20 cases were positive for EMVI and 34 cases were negative for EMVI by surgical and pathological results.The accuracy of EMVI assessed by MRI was 77.8%(42/54),sensitivity 80%(16/20),specificity 76.5%(26/34),positive predictive value 66.7%(16/24),predictive value 86.7%(26/30).MRI assessment and pathological results had a moderate consistency in the diagnosis of EMVI in rectal cancer,with a Kappa value of 0.542(P<0.001).Conclusion High-resolution magnetic resonance imaging is accurate and reliable in the assessment of extramural vascular invasion in rectal cancer,which can help guide clinicians to formulate appropriate individualized treatment strategies.