多期增强联合iShim-DWI与T_(2)WI对T1和T2期直肠癌术前分期的对照研究

Comparative study of dynamic contrast-enhanced MRI with iShim-DWI and T_(2)WI for preoperative staging of T1 and T2 rectal cancer

目的:比较磁共振多期增强联合iShim-DWI与T_(2)WI对T1和T2期直肠癌术前分期的价值。方法:回顾性分析本院2020年1月-2021年12月经病理证实的122例T1和T2期直肠癌患者的MRI表现。由两名具有10年以上腹盆部MRI诊断经验的医师分别采用多期增强联合iShim-DWI与T_(2)WI进行MRI的T分期评价,并进行一致性分析。对直肠癌MRI T分期结果与术后病理T分期结果进行χ^(2)检验对照分析,并结合受试者操作特征(ROC)曲线分析两种方式对直肠癌T分期的诊断效能(诊断符合率、敏感度、特异度、阳性预测值及阴性预测值)。结果:动态增强联合iShim-DWI与单独T_(2)WI对T1、T2期直肠癌诊断符合率对比分别为87.7%vs.62.3%、85.2%vs.46.7%,差异具有统计学意义(P<0.05)。多期增强联合iShim-DWI与单独T_(2)WI对T1期直肠癌敏感度、特异度、阳性预测值及阴性预测值分别为77.3%vs.13.2%、95.7%vs.100%、93.1%vs.100%、84.6%vs.60.0%;而对T2期直肠癌敏感度、特异度、阳性预测值及阴性预测值分别为85.5%vs.58.0%、84.9%vs.67.9%、88.1%vs.52.6%、81.8%vs.37.0%。多期增强联合iShim-DWI与单独T_(2)WI对T1、T2期直肠癌术前诊断的曲线下面积分别为0.865 vs.0.566、0.852 vs.0.450。结论:磁共振多期增强联合iShim-DWI对直肠癌T1和T2期的诊断效能高于T_(2)WI,对直肠癌手术方式的选择有重要指导意义。

Objective:To explore the value of dynamic contrast-enhanced(DCE)MRI with iShim-DWI and T_(2)WI for preoperative staging of rectal cancer patients with T1 and T2 stage.Methods:All 122 cases of pathologically confirmed T1 and T2 stage rectal cancer were retrospectively analyzed with MRI features between January 2020 and December 2021.Two radiologists with more than 10 years experience of abdominal and pelvic MRI image interpretation performed MRI T staging using multi-phase enhanced MRI with iShim-DWI and T_(2)WI,respectively,and consistency analysis was performed.The results of MRI T staging and postoperative pathological T staging were analyzed byχ^(2)test,and the diagnostic accuracy,sensitivity,specificity,positive predictive value(PPV)and negative predictive value(NPV)of the two methods for T staging were analyzed by using ROC curves analysis.Results:The diagnostic accuracy of DCE MRI combined with iShim-DWI and T_(2)WI for T1 and T2 rectal cancer were 87.7%vs.62.3%、85.2%vs.46.7%,with significant difference(P<0.05).The sensitivity,specificity,PPV and NPV of DCE MRI+iShim-DWI and conventional T_(2)WI alone were 77.3%vs.13.2%,95.7%vs.100%,93.1%vs.100%,84.6%vs.60.0%for T1 stage,and 85.5%vs.58.0%,84.9%vs.67.9%,88.1%vs.52.6%,81.8%vs.37.0%for T2 stage,respectively.Additionally,the area under the ROC were 0.865 vs.0.566,0.852 vs.0.450 for T1 and T2 stage,respectively.Conclusion:The diagnostic efficacy of DCE MRI combined with iShim-DWI for T1 and T2 staging of rectal cancer is higher than that of conventional T_(2)WI alone,providing important information of surgical planning.