多b值DWI联合HR-T_(2)WI在直肠癌术前分期及环周切缘评估中的应用

The application of multi b-value DWI combined with HR-T_(2)WI in preoperative staging and circumferential resection margin evaluation of rectal cancer

目的 探讨多b值扩散加权成像(DWI)联合高分辨率T2加权成像(HR-T2WI)在直肠癌术前分期及环周切缘(CRM)评估价值。方法 选取80例经病理确诊为直肠癌患者,术前均接受多b值DWI、HR-T2WI检查,比较不同T、N分期及CRM性质患者多b值下表观弥散系数(ADC)差异。以病理组织学检查为金标准,采用Kappa一致性检验多b值DWI联合HR-T2WI诊断结果与病理组织学诊断结果的一致性。结果 T1分期6例,T2分期20例,T3分期32例,T4分期22例;N0分期41例,N1分期23例,N2分期16例;CRM阴性49例,阳性31例。多b值下T1分期患者ADC高于T2、T3、T4分期,且T2分期高于T3、T4分期,T3分期高于T4分期,差异有统计学意义(P<0.05)。多b值下N0分期患者ADC高于N1、N2分期,N1分期高于N2分期,差异均有统计学意义(P<0.05);CRM阴性ADC高于阳性,差异有统计学意义(P<0.05)。HR-T2WI诊断4例T1分期,22例T2分期,31例T3分期,23例T4分期。HR-T2WI检出36例N0分期,28例N1分期,16例N2分期。经Kappa一致性检验显示,HR-T2WI诊断T分期、N分期、CRM性质结果与病理组织学结果存在较强一致性(Kappa=0.730、0.781、0.688,P<0.001)。多b值DWI联合HR-T2WI诊断5例T1分期,23例T2分期,31例T3分期,21例T4分期。多b值DWI联合HR-T2WI诊断39例N0分期,24例N1分期,17例N2分期。结论 多b值DWI联合HR-T2WI对直肠癌术前分期、CRM性质具有良好的诊断价值。

Objective To explore the application value of multi b-value diffusion-weighted imaging(DWI)combined with high-resolution T2 weighted imaging(HR-T2WI)in preoperative staging and circumferential resection margin(CRM)evaluation of rectal cancer.Method Retrospective collection of clinical data was performed from 80 patients diagnosed with rectal cancer through histopathology,all of whom underwent preoperative multi b-value DWI and HR-T2WI examinations.The differences in apparent diffusion coefficient(ADC)among patients with different T,N stages,and CRM properties under multiple b-values were compared.Histopathological examination was used as the gold standard,Kappa consistency test was used to verify the con‐sistency between the multi b-value DWI combined with HR-T2WI diagnostic results and histopathological diagnostic results.Re-sults There were 6 cases in T1 phase,20 cases in T2 phase,32 cases in T3 phase,and 22 cases in T4 phase;41 cases in N0 phase,23 cases in N1 phase,and 16 cases in N2 phase;49 cases were negative for CRM and 31 cases were positive.Under mul‐tiple b values,the ADC of T1 patients was higher than that of T2,T3,and T4,and T2 was higher than T3 and T4.T3 was higher than T4,with statistical significant differences(P<0.05).Under multiple b values,the ADC of N0 patients was higher than N1 and N2,and N1 was higher than N2,with statistical significant differences(P<0.05).CRM negative ADC was higher than posi‐tive,with statistical significant differences(P<0.05).HR-T2WI diagnosed 4 cases with T1 staging,22 cases with T2 staging,31 cases with T3 staging,and 23 cases with T4 staging.HR-T2WI detected 36 cases of N0 staging,28 cases of N1 staging,and 16 cases of N2 staging.According to the Kappa consistency test,there was a strong consistency between the HR-T2WI diagnostic T stage,N stage,CRM nature results and pathological histological results(Kappa=0.730,0.781,0.688,P<0.001).Multiple b-value DWI combined with HR-T2WI was used to diagnose 5 cases of T1 staging,23 cases of T2 staging,31 cases of T3 staging,and 21 cases of T4 staging.39 cases of N0 staging,24 cases of N1 staging,and 17 cases of N2 staging were diagnosed using multi b-value DWI combined with HR-T2WI.Conclusion The combination of multi b-value DWI and HR-T2WI has good diag‐nostic value for preoperative staging and CRM properties of rectal cancer.