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中华普通外科学文献(电子版) ›› 2011, Vol. 05 ›› Issue (06) : 524 -529. doi: 10.3877/cma.j.issn.1674-0793.2011.06.15

所属专题: 文献

论著

直肠癌3.0T磁共振弥散加权成像及其与病理的相关性研究
陈应明1, 庄晓曌2, 余深平1,(), 崔冀3, 陈创奇3, 赵晓娟1, 潘碧涛1, 李子平1   
  1. 1. 510080 广州,中山大学附属第一医院放射科
    2. 510080 广州,中山大学附属第一医院放射科(现在海南省人民医院放射科)
    3. 510080 广州,中山大学附属第一医院胃肠胰外科
  • 收稿日期:2011-09-08 出版日期:2011-12-01
  • 通信作者: 余深平
  • 基金资助:
    广东省科技计划项目(2010B080701037)

3.0T MR diffusion-weighted imaging in rectal cancer diagnosing and researching with pathology

Ying-ming CHEN1, Xiao-zhao ZHUANG2, Shen-ping YU1,(), Ji CUI3, Chuang-qi CHEN3, Xiao-juan ZHAO1, Bi-tao PAN1, Zi-ping LI1   

  1. 1. Department of Radiology, the First Affiliated Hospital of Sun Yat-sen University, 510080 Guangzhou, China
  • Received:2011-09-08 Published:2011-12-01
  • Corresponding author: Shen-ping YU
  • About author:
    Corresponding author: YU Shen-ping, Email:
引用本文:

陈应明, 庄晓曌, 余深平, 崔冀, 陈创奇, 赵晓娟, 潘碧涛, 李子平. 直肠癌3.0T磁共振弥散加权成像及其与病理的相关性研究[J/OL]. 中华普通外科学文献(电子版), 2011, 05(06): 524-529.

Ying-ming CHEN, Xiao-zhao ZHUANG, Shen-ping YU, Ji CUI, Chuang-qi CHEN, Xiao-juan ZHAO, Bi-tao PAN, Zi-ping LI. 3.0T MR diffusion-weighted imaging in rectal cancer diagnosing and researching with pathology[J/OL]. Chinese Archives of General Surgery(Electronic Edition), 2011, 05(06): 524-529.

目的

探讨3.0T磁共振背景抑制弥散加权成像(diffusion-weighted imaging with background suppression, DWIBS)对直肠癌的诊断价值,并分析其肿瘤表观弥散系数(apparent diffusion coefficient,ADC)值与病理的相关关系。

方法

收集42例直肠癌患者术前盆腔常规MRI及DWI的扫描资料,所有患者均接受直肠癌切除并病理组织学检查。测量肿瘤及正常直肠肠壁的ADC值并进行统计学分析。

结果

(1)直肠癌组与对照组的ADC值分别为(0.76 ± 0.11) × 10-3 mm2/s和(1.22 ± 0.16) × 10-3 mm2/s,两组比较差异有统计学意义(P < 0.001)。鉴别直肠癌与正常直肠肠壁的ADC值的最佳分界值为0.96 × 10-3 mm2/s,敏感性为95.2%,特异性为97.6%。(2)1例高分化,33例中分化及5例低分化直肠腺癌的ADC值分别为0.78 × 10-3 mm2/s,(0.75 ± 0.12) × 10-3 mm2/s及(0.77 ± 0.11)× 10-3 mm2/s。中分化与低分化直肠腺癌的ADC值比较差异无统计学意义(P > 0.05)。

结论

3.0T磁共振DWI能提高直肠癌的检出率,直肠癌原发灶的ADC值明显低于正常直肠肠壁的ADC值,不同分化程度的直肠腺癌的ADC值间无统计学差异。

Objective

To evaluate the efficacy of diffusion-weighted imaging with background suppression (DWIBS) at 3.0T magnetic resonance (MR) for diagnosing rectal cancer, and analyze the relationship between apparent diffusion coefficient (ADC) values and pathological results of tumor.

Methods

The study included 42 patients with rectal cancer who underwent preoperative routine MRI + DWI examination and were treated by rectal cancer dissection, and then obtained pathological results. ADC values of tumors and normal rectal walls were measured respectively, and statistical analysis was made.

Results

(1) The ADC values of total 42 patients of rectal primary tumors and normal rectal wall were (0.76 ± 0.11) × 10-3 mm2/s and (1.22 ± 0.16) × 10-3 mm2/s respectively. The ADC value of rectal cancer was statistically significant different from that of the normal rectal wall tissue (t = 15.439, P <0.001). The optimal cutoff ADC value in differentiating rectal cancer from normal rectal wall was (0.96 × 10-3) mm2/s, representing 95.2% sensitivity and 97.6% specificity. (2) The ADC values of one case of well differentiated, 33 cases of moderately differentiated and 5 cases of poorly differentiated rectal adenocarcinoma were 0.78 × 10-3 mm2/s, (0.75 ± 0.12) × 10-3 mm2/s and (0.77 ± 0.11) × 10-3 mm2/s respectively. There was no statistically difference between moderately differentiated and poorly differentiated rectal adenocarcinoma in ADC value (P > 0.05).

Conclusions

3.0T MR diffusion-weighted imaging can improve the tumor detection rate of rectal cancer. The ADC value of primary tumor is significantly lower than the normal rectal wall, and there is no statistically difference between different degrees of differentiation of rectal adenocarcinoma in ADC value.

图1 直肠癌并肠旁淋巴结磁共振背景抑制弥散加权成像
表1 直肠癌原发灶与正常直肠肠壁的ADC值比较( ± s
图3 直肠癌原发灶ADC值的ROC曲线
表2 直肠癌原发灶ADC值的ROC曲线分析结果
表3 不同分化程度的直肠腺癌ADC值比较
图2 直肠癌肿瘤病理改变(HE染色 ×200)
1
万德森,郑树森. 结直肠癌. 北京: 北京大学医学出版社, 2008.
2
Harewood GC. Assessment of publication bias in the reporting of EUS performance in staging rectal cancer. Am J Gastroenterol, 2005,100(4):808-816.
3
Leblanc JK. Imaging and management of rectal cancer. Nat Clin Pract Gastroenterol Hepatol, 2007,4(12):665-676.
4
郝帅营, 许卫, 李坤成,等. 3.0T磁共振扩散加权成像在直肠癌诊断中的价值. 临床放射学杂志, 2009,28(5):652-655.
5
姜军,周纯武,李颖,等. 64排CT薄层及多平面重建技术对不同部位和不同病理分期结直肠癌的术前T分期. 中国医学影像技术, 2009(12):2154-2158.
6
丛冠宁,秦明伟,有慧,等. 磁共振弥散加权成像结合常规序列在直肠癌诊断中的应用. 中国医学科学院学报, 2009,31(2):200-205.
7
Hosonuma T, Tozaki M, Ichiba N, et al. Clinical usefulness of diffusion-weighted imaging using low and high b-values to detect rectal cancer. Magn Reson Med Sci, 2006,5(4):173-177.
8
Soyer P, Lagadec M, Sirol M, et al. Free-breathing diffusion-weighted single-shot echo-planar MR imaging using parallel imaging (GRAPPA 2) and high b value for the detection of primary rectal adenocarcinoma. Cancer Imaging, 2010,10(1):32-39.
9
Thoeny H C, De Keyzer F. Extracranial applications of diffusion-weighted magnetic resonance imaging. Eur Radiol, 2007,17(6):1385-1393.
10
Koh DM, Collins DJ. Diffusion-weighted MRI in the body: applications and challenges in oncology. Am J Roentgenol, 2007, 188(6):1622-1635.
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