全身磁共振背景抑制扩散成像在直肠癌术前分期中的应用价值

The Application Value of Background Suppression Diffusion Weighted Imaging （ DWIBS） in Preoperative Staging of Rectal Cancer
XU Qinyan， SUN Shihang， SUN Xihe， et al． Department of Medical Imaging of Weifang Medical University， Department of Radiology， Affiliated hospital of Weifang Medical University， Weifang 261031 ， P． R． China
对 39 例经肠镜证实的直肠癌患者， 术前行全身磁共振 DWIBS 检查， 以直肠癌原发灶病理结果为标准将本组资料分 T3 、 T4 三组， 为 T2 、 分析原发灶 DWIBS 上肿瘤信号强度、 表观扩散系数（ ADC） 值、 肠壁病变厚度、 肠壁受累长度、 肿 瘤侵犯肠周径的情况五个指标在各组间的差异， 及其与 T 分期的相关性。 通过全身 DWIBS 图像作出术前 NM 分 期， 然后与术后 NM 病理分期结果进行对照， 判断 DWIBS 对直肠癌 NM 分期的准确性、 特异性及敏感性。 结果 全身 DWIBS 对直肠癌原发灶检出的敏感性为 100% ， 准确性为 100% ，DWIBS 上所显示的肠壁病变厚度和肠周径 P ＜ 0 ． 05 ；r s = 0 ． 384 ， P＜ 侵犯程度在各分期间有显著差异（ P ＜ 0． 05 ） ， 且两者与 T 分期均有显著相关性（ r s = 0 ． 427 ， 0． 05 ） ；原发灶肿瘤信号强度、 ADC 值、 肠壁受累长度在各分期间均无显著差异（ P ＞ 0． 05 ） 。 DWIBS 对 N 分期诊断 N1 期诊断的敏感性为 70． 00% ， 的总体准确性为 84． 61% ；对 N0 期诊断的敏感性为 85． 71% ， 特异性为 83． 33% ， 特 N2 期诊断的敏感性为 100% ， 异性为 89． 66% ， 特异性为 80． 65 % 。 对 M 期诊断的敏感性及准确性均为 100% 。 结论 全身 DWIBS 对直肠癌 NM 分期的诊断敏感性较高， 是显示转移性淋巴结及远处转移病灶的一种有效检查方 法。全身 DWIBS 对直肠癌原发灶检出的准确性及敏感性很高， 但在 T 分期中的应用有一定的限度， 结合常规 MRI 序列有助于提高 T 分期的准确性。 【关键词】 磁共振背景抑制扩散加权成像 直肠癌 肿瘤分期
临床放射学杂志 2012 年第 31 卷第 5 期
·癌术前分期中的应用价值
* 徐芹艳，孙世杭，孙西河 ，董
鹏，王锡臻，常光辉，管
玥，葛艳明
【摘要】 目的
探讨全身磁共振背景抑制扩散加权成像（ DWIBS） 对直肠癌术前分期的应用价值 。 资料与方法
【Abstract】 Objective To investigate the clinic value of background suppression diffusion weighted imaging （ DWIBS ）
in preoperative staging of rectal cancer． Materials and Methods 39 cases of rectal cancer confirmed by colonoscopy received DWIBS． The data was divided into three （ T2 ，T3 ，T4 ） groups on the basis of pathological results about T stage of rectal cancer． The relative signal intensity and the ADC values of the tumor were measured，the length，perimeter and thickness of the lesion were examined on DWIBS sequence． The difference of every index among groups and correlative analysis were taken． Preoperative NM staging was made，the results were compared with the results of pathological NM staging and the accuracy， specificity and sensitivity of DWIBS NM staging was calculated． Results Among 39 cancer lesions， DWIBS correctly detected 39 lesions，the sensitivity and accuracy both were 100% ． Thickness of the lesion were different from each other（ P ＜ 0． 05 ） except T2 and T3 ． The perimeter was different only between T2 and T4 （ P ＜ 0． 05 ） ，these two indexes were positively correlated with T stages （ r s = 0 ． 427 ，P ＜ 0 ． 05 ； r s = 0 ． 384 ，P ＜ 0． 05 ） ． Difference about the length，relative signal intensity and ADC values of the lesion could not be found among different T stages（ P ＞ 0． 05 ） ． The overall diagnostic accuracy rate of N staging was 84． 61% ； For N0 stage the sensitivity was 85． 71% ，the specificity was 83． 33% ． For N1 stage，the diagnostic sensitivity was 70． 00% ，the specificity was 89． 66% ． For N2 stage，the sensitivity was 100% ，specificity was 80． 65% ． 6 cases of distant metastasis were correctly diagnosed by DWIBS． Conclusion DWIBS is sensitive and accuracy in NM staging of rectal cancer， it is an effective method to show the metastatic lymph node and distant metastasis， and also has high accuracy and sensitivity in detecting the primary tumor of rectal cancer． However，