MRI扩散加权成像在直肠癌术前诊断中的应用优势
|
摘要
目的探讨MRI扩散加权成像(DWI)在直肠癌术前癌局部定位穿刺活检中的应用价值。方法回顾性分析本院2013年12月至2016年12月收治的80例直肠癌患者的临床资料,所有患者均经内镜检查高度怀疑直肠癌,经首次内镜活检未发现癌组织,继续接受MR检查提示存在直肠癌,并在MR影像指导下再次予以内镜活检,活检定位分为常规序列图像和表观扩散系数(ADC)图像。按照不同的定位方式确定活检部位,获得组织颗粒进行病理分析,分析不同定位方式的活检结果以及活检部位一致性对活检结果的影响。组间数据差异比较的采用t检验和χ~2检验。结果入组的80例患者经不同定位方式一共获得240个活检组织颗粒,MRI常规定位、内镜定位以及MRI ADC定位之间的活检阳性率分别为52.5%,42.5%,70.0%,3种方法检测的阳性率差异有统计学意义(χ~2=12.53,P<0.05),内镜定位与MRI ADC定位之间活检阳性率比较,差异有统计学意义(42.5%vs.70.0%,χ~2=12.29,P<0.05)。入组的80例患者中,有44例经两种MRI定位方式确定的活检方向不一致,剩余36例一致。活检方向一致性对MRI常规定位的阳性率存在影响(77.8%vs.22.7%,χ~2=24.06,P<0.05),但对MRI ADC定位的阳性率无影响(77.8%vs.63.6%,χ~2=1.89,P>0.05)。当活检方向不一致的时候,MRI常规定位的阳性率显著小于MRI ADC定位(22.7%vs.63.6%,χ~2=15.01,P<0.05)。结论 MRI DWI在直肠癌术前诊断中可显著提高直肠癌内镜单次活检的阳性率。
Objective To investigate the value of MRI diffusion-weighted imaging in local biopsy of preoperative cancer for rectal cancer. Methods The clinical data of 80 patients with rectal cancer admitted to our hospital from December 2013 to December 2016 were retrospectively analyzed. All patients were highly suspected of rectal cancer by endoscopy. No cancer tissue was found after the first endoscopic biopsy. MR examination indicated the presence of rectal cancer, and endoscopic biopsy was performed under the guidance of MR imaging. The biopsy location was divided into regular sequence images and ADC images. The biopsy site was determined according to different positioning methods, and the tissue particles were obtained for pathological analysis, and the biopsy results of different positioning methods and the consistency of biopsy site consistency on the biopsy results were analyzed. The t-test and χ~2 test were used to compare the difference in data between groups. Results A total of 240 biopsy granules were obtained from 80 patients. The positive biopsy rates between MRI routine location, endoscopic localization and MRIADC location were 52.5%, 42.5%, and 70.0%, respectively. The positive rate difference was statistically significant(χ~2=12.53, P<0.05). The positive rate of biopsy between endoscopic localization and MRI ADC localization was statistically significant(42.5% vs. 70.0%, χ~2=12.29, P<0.05). Of the 80 patients enrolled, 44 had a biopsy direction determined by two MRI localization methods, and the remaining 36 were consistent. The consistency of biopsy direction had an effect on the positive rate of MRI routine localization(77.8% vs. 22.7%, χ~2=24.06, P<0.05), but had no effect on the positive rate of MRI ADC localization(77.8% vs. 63.6%, χ~2= 1.89, P>0.05). When the direction of biopsy was inconsistent, the positive rate of MRI conventional positioning was significantly smaller than that of MRI ADC(22.7% vs. 63.6%, χ~2=15.01, P<0.05). Conclusion MRI diffusion-weighted imaging can significantly improve the positive rate of endoscopic single biopsy in rectal cancer in preoperative diagnosis of rectal cancer.
Objective To investigate the value of MRI diffusion-weighted imaging in local biopsy of preoperative cancer for rectal cancer. Methods The clinical data of 80 patients with rectal cancer admitted to our hospital from December 2013 to December 2016 were retrospectively analyzed. All patients were highly suspected of rectal cancer by endoscopy. No cancer tissue was found after the first endoscopic biopsy. MR examination indicated the presence of rectal cancer, and endoscopic biopsy was performed under the guidance of MR imaging. The biopsy location was divided into regular sequence images and ADC images. The biopsy site was determined according to different positioning methods, and the tissue particles were obtained for pathological analysis, and the biopsy results of different positioning methods and the consistency of biopsy site consistency on the biopsy results were analyzed. The t-test and χ~2 test were used to compare the difference in data between groups. Results A total of 240 biopsy granules were obtained from 80 patients. The positive biopsy rates between MRI routine location, endoscopic localization and MRIADC location were 52.5%, 42.5%, and 70.0%, respectively. The positive rate difference was statistically significant(χ~2=12.53, P<0.05). The positive rate of biopsy between endoscopic localization and MRI ADC localization was statistically significant(42.5% vs. 70.0%, χ~2=12.29, P<0.05). Of the 80 patients enrolled, 44 had a biopsy direction determined by two MRI localization methods, and the remaining 36 were consistent. The consistency of biopsy direction had an effect on the positive rate of MRI routine localization(77.8% vs. 22.7%, χ~2=24.06, P<0.05), but had no effect on the positive rate of MRI ADC localization(77.8% vs. 63.6%, χ~2= 1.89, P>0.05). When the direction of biopsy was inconsistent, the positive rate of MRI conventional positioning was significantly smaller than that of MRI ADC(22.7% vs. 63.6%, χ~2=15.01, P<0.05). Conclusion MRI diffusion-weighted imaging can significantly improve the positive rate of endoscopic single biopsy in rectal cancer in preoperative diagnosis of rectal cancer.
引文
1 厚磊,廖苏苏,姜晶梅,等.筛查与结直肠癌发病率关系的系统综述和荟萃分析[J].中华医学杂志,2017,97:3492-3497.
2 李冬冬,许哲.探讨结直肠癌肝转移患者手术治疗的疗效和生存率的有关因素[J].当代医学,2017,23:65-67.
3 陈慧敏,马亚娜.MDT模式对结直肠癌肝转移患者手术切除率及生存率的影响[J].中国保健营养,2016,26:71-72.
4 周颖洁,吴勤荣.CT影像诊断对直肠癌的临床术前分期价值分析[J].医学信息,2017,30:180-181.
5 魏士星,蒋瑞华,桂振朝,等.CT、MRI影像诊断对直肠癌临床术前分期价值研究[J].影像研究与医学应用,2017,1:10-12.
6 张晔锋,许建洪.CT影像诊断对直肠癌临床术前分期的价值[J].影像研究与医学应用,2017,1:185-187.
7 李伟,李建生,张海南,等.MR扩散加权成像对提高直肠癌内镜活检阳性率价值分析[J].中华肿瘤防治杂志,2015,22:382-386.
8 叶文钦,陈泽文,陈忠,等.多参数MRI在结直肠癌诊断中的应用价值[J].中国CT和MRI杂志,2017,15:135-138.
9 么旺,滕翀.螺旋CT和磁共振成像检查进行直肠癌术前肿瘤原发灶浸润深度和淋巴结转移准确性研究[J].中国CT和MRI杂志,2017,15:115-118.
10 宋天彬,卢洁.磁共振扩散加权成像在直肠癌新辅助放化疗中的应用价值[J].协和医学杂志,2017,8:106-111.
11 白毓,罗鸣,张鹏.磁共振IVIM-DWI及DCE-MRI在直肠癌诊断中的应用价值[J].解放军医药杂志,2017,29:89-92,96.
12 谢宗源,王志强,谭志斌,等.磁共振功能成像在直肠癌T分期中的应用价值[J].实用医学杂志,2017,33:1303-1306.
13 宁浩勇,虞积耀.读新版WHO(2010)消化系统肿瘤分类[J].诊断病理学杂志,2011,18:81-84.
14 杨智钧,尚乃舰,张红霞.MR扩散加权成像及背景抑制扩散加权成像对直肠癌术前转移淋巴结的辅助诊断价值[J].临床放射学杂志,2014,33:744-748.
15 曹务腾,周智洋,邓艳红,等.磁共振扩散加权成像对直肠癌新辅助治疗后病理完全缓解的预测价值[J].中华胃肠外科杂志,2013,16:1164-1168.
16 苏艳,龚永泉,刘振兴,等.MRI常规序列联合DWI对结直肠癌病变的诊断意义[J].实用肿瘤杂志,2017,32:156-158.
17 郑昊宇,张旭毅,张毅.扩散加权成像表观扩散系数及其相对值测定对直肠癌周围淋巴结定性诊断的价值[J].武警医学,2017,28:64-67.
18 谢宗源,王志强,李晖,等.fMRI参数与直肠癌患者病理学分期及淋巴结转移的关系[J].山东医药,2017,57:45-47.
19 Attenberger UI,Pilz LR,Morelli JN,et al.Multi-parametric MRI of rectal cancer - Do quantitative functional MR measurements correlate with radiologic and pathologic tumor stages?[J].Eur J Radiol,2014,83:1036-1043.
20 亓俊霞,白人驹,于长路,等.磁共振扩散加权成像对直肠癌的显示及其恶性程度评估的初步研究[J].实用放射学杂志,2013,29:400-404.
21 亓俊霞,白人驹,张翔,等.薄层MRI联合MR扩散加权成像对直肠癌术前局部分期的价值[J].临床放射学杂志,2011,30:1783-1787.
22 张文娟,蒋健,叶建军,等.扩散加权成像ADC值与直肠癌预后因素的相关性研究[J].中国医学影像技术,2013,29:1665-1669.
2 李冬冬,许哲.探讨结直肠癌肝转移患者手术治疗的疗效和生存率的有关因素[J].当代医学,2017,23:65-67.
3 陈慧敏,马亚娜.MDT模式对结直肠癌肝转移患者手术切除率及生存率的影响[J].中国保健营养,2016,26:71-72.
4 周颖洁,吴勤荣.CT影像诊断对直肠癌的临床术前分期价值分析[J].医学信息,2017,30:180-181.
5 魏士星,蒋瑞华,桂振朝,等.CT、MRI影像诊断对直肠癌临床术前分期价值研究[J].影像研究与医学应用,2017,1:10-12.
6 张晔锋,许建洪.CT影像诊断对直肠癌临床术前分期的价值[J].影像研究与医学应用,2017,1:185-187.
7 李伟,李建生,张海南,等.MR扩散加权成像对提高直肠癌内镜活检阳性率价值分析[J].中华肿瘤防治杂志,2015,22:382-386.
8 叶文钦,陈泽文,陈忠,等.多参数MRI在结直肠癌诊断中的应用价值[J].中国CT和MRI杂志,2017,15:135-138.
9 么旺,滕翀.螺旋CT和磁共振成像检查进行直肠癌术前肿瘤原发灶浸润深度和淋巴结转移准确性研究[J].中国CT和MRI杂志,2017,15:115-118.
10 宋天彬,卢洁.磁共振扩散加权成像在直肠癌新辅助放化疗中的应用价值[J].协和医学杂志,2017,8:106-111.
11 白毓,罗鸣,张鹏.磁共振IVIM-DWI及DCE-MRI在直肠癌诊断中的应用价值[J].解放军医药杂志,2017,29:89-92,96.
12 谢宗源,王志强,谭志斌,等.磁共振功能成像在直肠癌T分期中的应用价值[J].实用医学杂志,2017,33:1303-1306.
13 宁浩勇,虞积耀.读新版WHO(2010)消化系统肿瘤分类[J].诊断病理学杂志,2011,18:81-84.
14 杨智钧,尚乃舰,张红霞.MR扩散加权成像及背景抑制扩散加权成像对直肠癌术前转移淋巴结的辅助诊断价值[J].临床放射学杂志,2014,33:744-748.
15 曹务腾,周智洋,邓艳红,等.磁共振扩散加权成像对直肠癌新辅助治疗后病理完全缓解的预测价值[J].中华胃肠外科杂志,2013,16:1164-1168.
16 苏艳,龚永泉,刘振兴,等.MRI常规序列联合DWI对结直肠癌病变的诊断意义[J].实用肿瘤杂志,2017,32:156-158.
17 郑昊宇,张旭毅,张毅.扩散加权成像表观扩散系数及其相对值测定对直肠癌周围淋巴结定性诊断的价值[J].武警医学,2017,28:64-67.
18 谢宗源,王志强,李晖,等.fMRI参数与直肠癌患者病理学分期及淋巴结转移的关系[J].山东医药,2017,57:45-47.
19 Attenberger UI,Pilz LR,Morelli JN,et al.Multi-parametric MRI of rectal cancer - Do quantitative functional MR measurements correlate with radiologic and pathologic tumor stages?[J].Eur J Radiol,2014,83:1036-1043.
20 亓俊霞,白人驹,于长路,等.磁共振扩散加权成像对直肠癌的显示及其恶性程度评估的初步研究[J].实用放射学杂志,2013,29:400-404.
21 亓俊霞,白人驹,张翔,等.薄层MRI联合MR扩散加权成像对直肠癌术前局部分期的价值[J].临床放射学杂志,2011,30:1783-1787.
22 张文娟,蒋健,叶建军,等.扩散加权成像ADC值与直肠癌预后因素的相关性研究[J].中国医学影像技术,2013,29:1665-1669.
© 2004-2018 中国地质图书馆版权所有 京ICP备05064691号 京公网安备11010802017129号 地址：北京市海淀区学院路29号 邮编：100083 电话：办公室：(+86 10)66554848；文献借阅、咨询服务、科技查新：66554700 |