【摘要】 目的：探讨MRI平衡式稳态自由进动序列（b SSFP）协同体素内不相干运动扩散加权成像（IVIM-DWI）、Gd-DTPA增强扫描术前对直肠癌壁外血管（EMVI）状态的预测价值。方法：回顾性选取就诊于安徽省庐江县人民医院病理证实的直肠癌患者105例，术前均行b SSFP序列、IVIM-DWI功能成像及Gd-DTPA增强多参数MRI扫描。结合MRI常规序列，运用基于单独b SSFP序列、IVIM-DWI功能成像及Gd-DTPA增强，两两协同以及多序列联合诊断三种七分制方案对EMVI状态术前预测。以术后病理结果作为诊断依据，首先对比T2WI序列及b SSFP序列诊断效能；然后依次绘制ROC曲线图，得出对应ROC曲线下面积（AUC）、特异度及敏感度。结果：常规T2抑脂序列对直肠壁外血管状态术前预测AUC:0.572(95%CI:0.408～0.737)，特异度为0.811，敏感度为0.667;b SSPF序列AUC:0.817(95%CI:0.680～0.954)，特异度为0.900，敏感度为0.733；各统计学参数均高于常规T2抑脂序列的诊断效能。多序列MRI协同诊断AUC:0.961(95%CI:0.886～1.000)，特异度为0.988，敏感度为0.875，诊断效能最佳（P<0.05）。结论：磁共振b SSFP序列协同IVIM-DWI、Gd-DTPA增强多参数扫描对术前预测直肠癌EMVI侵犯具有较高临床应用价值。更多还原

【Abstract】 Objective: To investigate the predictive value of MRI balanced steady-state free precession(b SSFP) synergistic voxel incoherent motion diffusion weighted imaging(IVIM-DWI) and Gd-DTPA enhanced scanning for the status of extramural vascular invasion(EMVI) in rectal cancer before surgery. Methods: A total of 105 rectal cancer patients from the People’s Hospital of Lujiang County, Anhui Province, were retrospectively selected and included. All patients were confirmed by postoperative pathology and underwent preoperative b SSFP sequences, IVIM-DWI functional imaging, and Gd-DTPA-enhanced multiparameter MRI scans. Three seven-point schemes based on individual b SSFP sequences, IVIM-DWI functional imaging, and Gd-DTPA enhancement, two-by-two synergy, and multi-sequence combined diagnosis were utilized in conjunction with conventional MRI sequences for preoperative prediction of EMVI status. The diagnostic efficacy of T2WI and b SSFP sequences was compared with that of postoperative pathologic results. ROC curves were plotted to obtain the corresponding area under the ROC curve(AUC), specificity, and sensitivity. Results: The AUC for predicting the preoperative vascular status outside the rectal wall was 0.572(95% CI: 0.408～0.737) for the conventional T2 lipid suppression sequence, with a specificity of 0.811 and a sensitivity of 0.667. The AUC for the b SSPF sequence was 0.817(95% CI: 0.680～0.954), with a specificity of 0.900 and a sensitivity of 0.733.All of the statistical parameters were higher than the diagnostic efficacy of conventional T2 lipid suppression sequences. The multi-sequence MRI co-diagnosis had an AUC of 0.961(95% CI: 0.886～1.000), with a specificity of 0.988 and a sensitivity of 0.875(P<0.05).Conclusion: Magnetic resonance b SSFP sequence synergized with IVIM-DWI and Gd-DTPA-enhanced multiparameter scanning has high clinical application value for the preoperative prediction of EMVI invasion in rectal cancer.更多还原