3.0T MRI对原发性直肠癌患者术前肿瘤局部浸润程度的评估价值

Evaluation Value of 3.0T MRI for Local Tumor Invasion in Patients with Primary Rectal Cancer

目的分析3.0T磁共振成像(MRI)对原发性直肠癌患者术前肿瘤局部浸润程度的评估价值。方法回顾性分析127例原发性直肠癌患者临床资料,患者术前均进行3.0T MRI扫描对直肠癌局部浸润征象做出分期诊断,并与术后病理组织学肿瘤T分期进行对照,以组织病理学结果作为金标准,计算3.0T MRI在评价肿瘤局部浸润程度的总的准确性及各分期的准确性、敏感度、特异度、阳性预测值、阴性预测值。结果127例原发性直肠癌患者中,经病理组织学确诊T2分期患者29例,T3分期患者55例,T4分期患者43例,3.0T MRI诊断T2分期患者31例,T3分期患者47例,T4分期患者49例,3.0T MRI诊断T分期与病理组织学诊断对照,kappa一致性为0.663,准确率为77.95%(99/127)。3.0T MRI对原发性直肠癌患者术前肿瘤局部浸润程度的诊断效能各有差异,T4分期的诊断效能较高,T2分期的诊断效能次之,T3分期的诊断效能较差,与病理组织学诊断对照,T2、T3、T4分期的kappa一致性分别为0.695、0.543、0.762,敏感度分别为79.31%、67.27%、90.70%,特异度分别为91.84%、86.11%、88.10%,准确率分别为88.98%、77.95%、88.98%,阳性预测值分别为74.19%、78.72%、79.59%,阴性预测值分别为93.75%、77.50%、94.87%。结论3.0T MRI对原发性直肠癌患者术前肿瘤局部浸润程度有较好的评估价值,尤其是T4分期的诊断效能较高。

Objective To analyze the evaluation value of 3.0T magnetic resonance imaging(MRI)for local tumor invasion in patients with primary rectal cancer.Methods A retrospective analysis was performed on the clinical data of 127 patients with primary rectal cancer.All underwent 3.0T MRI scan for staging diagnosis of rectal cancer.The tumor T staging by and 3.0T MRI was compared.Taking histopathology results as the golden standard,overall accuracy of 3.0T MRI in evaluating local tumor invasion,and its sensitivity,specificity,positive predictive value and negative predictive value for different stages of tumors were calculated.Results Among the 127 patients with primary rectal cancer,histopathology showed that there were 29 cases at stage T2,55 cases at stage T3 and 43 cases at stage T4.3.0T MRI showed that there were 31 cases at stage T2,47 cases at stage T3 and 49 cases at stage T4.The kappa consistency between 3.0T MRI and histopathology in the diagnosis of T staging was 0.663,and its accuracy rate was 77.95%(99/127).The diagnostic efficiency of 3.0T MRI was different for different severity of local tumor invasion.The diagnostic efficiency for stage T4 was the highest,followed by stage T2 and stage T3.The kappa consistency values between 3.0T MRI and histopathology in the diagnosis of tumors at stages T2,T3 and T4 were 0.695,0.543 and 0.762,the sensitivity were 79.31%,67.27%and 90.70%,the specificity were 91.84%,86.11%and 88.10%,the accuracy were 88.98%,77.95%and 88.98%,the positive predictive value were 74.19%,78.72%and 79.59%,the negative predictive value were 93.75%,77.50%and 94.87%,respectively.Conclusion 3.0T MRI has good evaluation value for the severity of local tumor invasion in patients with primary rectal cancer.Especially,diagnostic efficiency is higher for stage T4.