| 王子,葛宇曦,贺锋,周心一,窦维强,胡曙东.高分辨率T2WI联合合成双反转恢复图像判断直肠癌T分期[J].中国医学影像技术,2022,38(9):1350~1355 |
| 高分辨率T2WI联合合成双反转恢复图像判断直肠癌T分期 |
| High resolution T2WI combined with synthetic double inversion recovery images for T staging of rectal cancer |
| 投稿时间：2022-04-14 修订日期：2022-05-21 |
| DOI：10.13929/j.issn.1003-3289.2022.09.016 |
| 中文关键词: 直肠肿瘤 肿瘤分期 磁共振成像 |
| 英文关键词:rectal neoplasms neoplasm staging magnetic resonance imaging |
| 基金项目:无锡市卫生健康委科技成果与适宜技术推广项目（T202036）。 |
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| 中文摘要: |
| 目的 观察合成MRI(SyMRI)定量参数及高分辨率T2WI(HR-T2WI)联合合成双反转恢复(SyDIR)图用于直肠癌T分期的价值。方法 回顾性分析79例经病理证实直肠腺癌，将病理T1及T2期归为肌层未突破组、T3及T4期归为肌层突破组。由2名影像科医师(分别具有低及高年资)基于HR-T2WI及联合SyDIR图行直肠癌T分期，观察其与病理结果的一致性，计算T分期诊断准确率；比较组间SyMRI定量参数值T1、T2及质子密度(PD)的差异。绘制受试者工作特征曲线，计算曲线下面积(AUC)，评估HR-T2WI及其联合SyDIR图和T2值诊断直肠癌突破肌层的效能。结果 79例中，病理T分期T1期3例， T2期32例， T3期27例， T4期17例。2名医师基于HR-T2WI判断直肠癌T分期与病理结果的一致性均较强(Kappa=0.626、0.784，P均<0.001)，诊断准确率分别为75.95%(60/79)及86.08%(68/79)；基于HR-T2WI联合SyDIR图判断直肠癌T分期与病理结果的一致性为较强及强(Kappa=0.783、0.829，P均<0.001)，诊断准确率分别为84.81%(67/79)及88.61%(70/79)。低年资医师基于HR-T2WI联合SyDIR图判断直肠癌突破肌层的AUC(0.940)高于基于单一HR-T2WI(AUC=0.843，Z=2.443，P=0.015)；高年资医师基于HR-T2WI联合SyDIR图的AUC(0.954)与基于单一HR-T2WI差异无统计学意义(AUC=0.943，Z=0.366，P=0.720)，后者与低年资医师基于HR-T2WI联合SyDIR图差异无统计学意义(Z=0.108，P=0.918)。2名医师所测肌层未突破组T2值均高于肌层突破组(P均<0.001)，其余定量参数差异均无统计学意义(P均>0.05)；根据T2值判断直肠癌突破肌层的AUC为0.812。结论 SyMRI定量参数T2值对判断直肠癌T分期具有一定价值；HR-T2WI联合SyDIR图有助于提高低年资影像科医师判断直肠癌T分期的效能。 |
| 英文摘要: |
| Objective To investigate the value of synthetic MRI (SyMRI) quantitative parameters and high resolution T2WI (HR-T2WI) combined synthetic double reverse recovery (SyDIR) images for T staging of rectal cancer. Methods Data of 79 patients with rectal adenocarcinoma confirmed by postoperative pathology were retrospectively analyzed. Patients with pathological stages T1 and T2 were enrolled in muscle layer non-breakthrough group, with T3 and T4 were enrolled in muscle layer breakthrough group. T staging of rectal cancer was performed by a junior also a senior radiologists based on HR-T2WI and combination with SyDIR images. The consistency of 2 radiologists for T staging of rectal cancer based on HR-T2WI, combination with SyDIR images and pathological T staging were analyzed, respectively, and the accuracies of T staging were calculated. SyMRI quantitative parameters, including T1, T2 and proton density (PD) values were compared between groups. Receiver operating characteristic curve was drawn, and area under the curve (AUC) was calculated to evaluate the efficacy of HR-T2WI, combination of HR-T2WI with SyDIR images and T2 value for diagnosing rectal cancer breakthrough muscle layer. Results Among 79 cases, the pathological T stages of rectal cancers included T1 in 3 cases, T2 in 32 cases, T3 in 27 cases and T4 in 17 cases.There were both fairly strong consistency in T staging of rectal cancer by 2 radiologists based on HR-T2WI with those of pathology (Kappa=0.626, 0.784, both P<0.001), and the diagnostic accuracy was 75.95% (60/79) and 86.08% (68/79), respectively. Based on the combination of HR-T2WI and SyDIR images, there were fairly strong and strong consistency in T staging of rectal cancer by each radiologist and pathology (Kappa=0.783, 0.829, both P<0.001), and the diagnostic accuracy was 84.81% (67/79) and 88.61% (70/79), respectively. The AUC of junior radiologist (0.940) for diagnosing rectal cancer breakthrough muscle layer based on HR-T2WI combined with SyDIR images was higher than based on HR-T2WI (AUC=0.843, Z=2.443, P=0.015), while of senior radiologist (0.954) based on HR-T2WI combined with SyDIR images and HR-T2WI were not significant different(AUC=0.943, Z=0.366, P=0.720), so were AUC of junior radiologist based on HR-T2WI combined with SyDIR images and of senior radiologist based on HR-T2WI (Z=0.108, P=0.918). T2 value measured by 2 radiologists in muscle layer non-breakthrough group was higher than that in breakthrough group (both P<0.001), while no significant difference of the other quantitative parameters was found between groups (all P>0.05). AUC of T2 value for diagnosing rectal cancer breakthrough muscle layer was 0.812. Conclusion SyMRI quantitative parameter T2 value had certain value for T staging of rectal cancer. HR-T2WI combined with SyDIR images could improve the efficacy of junior radiologist in T staging of rectal cancer. |
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