多参数MRI联合临床危险因素术前预测直肠癌淋巴血管间隙侵犯的应用价值

Multi-parametric MRI combined with clinical risk factors in preoperative prediction of lymphovascular space invasion in rec⁃tal cance

目的探讨多参数MRI联合临床危险因素术前预测直肠癌淋巴血管间隙侵犯(LSVI)的价值。方法回顾性分析池州市人民医院2022年4月至2023年11月经术后病理证实的38例直肠癌患者的临床及影像学资料,所有患者均行常规MRI、合成MRI及IVIM-DWI序列扫描。依据术后病理结果分为LVSI阳性组(n=14)和LVSI阴性组(n=24)。采用单因素和多因素logistic回归分析LVSI阳性组和LVSI阴性组的临床资料,分析LVSI的临床危险因素;比较两组患者合成MRI(T1值、T2值、PD值)及IVIM-DWI参数(D值、D*值、f值),采用受试者工作特征(ROC)曲线评价各定量参数预测模型及联合临床危险因素预测模型的诊断效能。结果合成MRI的T2值及IVIM-DWI的D值、f值在直肠癌LVSI阳性组和阴性组中比较差异具有统计学意义(P<0.05)。术前CEA(OR=10.818,95%CI:1.391~84.124)及临床N分期(OR=11.852,95%CI:1.534~91.552)是直肠癌LVSI的独立危险因素(P<0.05)。单独的T2值、D值、f值及三者联合的曲线下面积(AUC)分别为0.801、0.747、0.766、0.807,联合临床危险因素的预测模型效能最高(AUC=0.845),灵敏度为78.58%,特异度为100%。结论多参数MRI术前可有效预测直肠癌LVSI的状态,结合临床危险因素的联合预测模型可进一步提升预测效能,有助于临床医师制定个性化直肠癌治疗方案。

Objective To investigate the value of multi-parametric MRI combined with clinical risk factors in preoperative prediction of lymphovascular space invasion(LSVI)in rectal cancer.Methods The clinical and imaging data of 31 patients with rectal cancer confirmed by postoperative pathology in Chizhou People's Hospital from April 2022 to August 2023 were selected.All patients underwent conventional MRI,synthetic MRI and IVIM-DWI sequence scanning.According to the postoperative pathological results,the patients were divided into the LVSI positive group(10 cases)and LVSI negative group(21 cases).The clinical data of LVSI positive group and LVSI negative group were analyzed by univariate and multivariate logistic regression to determine the clinical risk factors of LVSI.Synthetic MRI(T1 value,T2 value,PD value)and IVIM-DWI parameters(D value,D*value,f value)were compared between the two groups.The diagnostic efficacy of the prediction model of each quantitative parameter and the prediction model combined with clinical risk factors were assessed using the receiver operating characteristic curve(ROC).Results The T2 value of synthetic MRI,D value and f value of IVIM-DWI were significantly different in LVSI positive and negative group of rectal cancer(P<0.05).Preoperative CEA(OR=10.818,95%CI:1.391~84.124)and clinical N stage(OR=11.852,95%CI:1.534~91.552)were independent risk factors for LVSI in rectal cancer(P<0.05).The AUC of T2 value,D value,f value and the combination of the three values were 0.801,0.747,0.766 and 0.807,respectively.The prediction model combined with clinical risk factors had the highest performance(AUC=0.845),with a sensitivity of 78.58%and a specificity of 100%.Conclusion Multi-parametric MRI can effectively preoperatively predict the status of LVSI in rectal cancer.The prediction model combined with clinical risk factors can further improve the pre‑diction efficiency,which is helpful for clinicians to make personalized treatment plans for rectal cancer.