【摘要】 目的 探讨高分辨率磁共振成像(HR-MRI)与小视野扩散加权成像(r-FOV DWI)联合成像在直肠癌术前TN分期中的应用价值。方法 收集经手术病理证实的74例直肠癌患者的临床及影像资料,以直肠癌病理分期结果为标准,分析HR-MRI及与r-FOV DWI联合对直肠癌术前TN分期的情况。结果 在T1、T2、T3及T4期直肠癌患者中,HR-MRI及与r-FOV DWI相联合诊断的灵敏度分别为75.0%、71.8%、75.8%、80.0%,87.5%、84.3%、86.2%、80.0%;特异度分别为100.0%、78.6%、78.6%、100%,100%、88.1%、88.6%、100.0%;准确度分别为97.3%、75.7%、77.0%、98.6%,98.6%、86.5%、86.5%、98.6%。与病理T分期对照,HR-MRI及与r-FOV DWI相联合对直肠癌T分期的一致性分别为中等(Kappa=0.593,P<0.01)、高度一致(Kappa=0.766,P<0.01)。HR-MRI及与r-FOV DWI相联合对N0、N1、N2期直肠癌诊断的灵敏度分别为66.7%、55.6%、63.6%,75.6%、61.1%、72.7%;特异度分别为89.7%、69.6%、92.1%,86.2%、76.8%、95.2%;准确度分别为75.7%、63.5%、87.8%,79.7%、71.6%、91.9%。与病理N分期对照,HR-MRI及与r-FOV DWI相联合对直肠癌N分期的一致性分别为一般(Kappa=0.401,P<0.01)、中等(Kappa=0.514,P<0.01)。结论 与单独HR-MRI对比,HR-MRI联合r-FOV DWI有助于提高直肠癌T分期的准确性,有利于直肠癌T2及T3期的鉴别,HR-MRI联合r-FOV DWI对于直肠癌N分期的准确性中等,有待进一步定量研究。更多还原

【Abstract】 Objective To explore the application value of high-resolution MRI(HR-MRI) combined with reduced field of view diffusion weighted imaging(r-FOV DWI) in preoperative TN staging of rectal cancer.Methods The clinical and imaging data of 74 patients with rectal cancer confirmed by surgical pathology were collected.According to the pathological staging of rectal cancer, the accuracy of HR-MRI and HR-MRI combined with r-FOV DWI in preoperative TN staging of rectal cancer were analyzed.Results For patients with T1,T2,T3 and T4 stage rectal cancer, the diagnostic sensitivity of HR-MRI and HR-MRI combined with r-FOV DWI was 75.0%、71.8%、75.8%、80.0%,87.5%、84.3%、86.2%、80.0%,respectively; the diagnostic specificity was 100.0%,78.6%,78.6%,100%,100%,88.1%,88.6%,100.0%,respectively; and the diagnostic accuracy was 97.3%,75.7%,77.0%,98.6%,98.6%,86.5%,86.5%,98.6%,respectively.Compared with pathological T stage, the consistency of HR-MRI and HR-MRI combined with r-FOV DWI in T stage of rectal cancer was moderate(Kappa=0.593,P<0.01)and high(Kappa=0.766,P<0.01),respectively.For patients with rectal cancer of N0,N1 and N2 stage, the diagnostic sensitivity of HR-MRI and HR-MRI combined with r-FOV DWI was 66.7%,55.6%,63.6%,75.6%,61.1%,72.7%,respectively; the diagnostic specificity was 89.7%,69.6%,92.1%,86.2%,76.8%,95.2%,respectively; and the diagnostic accuracy was 75.7%,63.5%,87.8%,79.7%,71.6%,91.9%,respectively.Compared with pathological N stage, the consistency of HR-MRI and HR-MRI combined with r-FOV DWI in N stage of rectal cancer was ordinary(Kappa=0.401,P<0.01)and moderate(Kappa=0.514,P<0.01),respectively.Conclusion Compared with HR-MRI alone, HR-MRI combined with r-FOV DWI can improve the accuracy of T staging of rectal cancer and is beneficial to distinguish T2 and T3 stage of rectal cancer.The accuracy of HR-MRI combined with r-FOV DWI in N staging of rectal cancer is moderate, which needs further quantitative research.更多还原