3.0T磁共振常规序列联合DWI在结直肠癌诊断中的价值

发布时间：2018-04-30 06:07

本文选题：结直肠癌 + 磁共振　；参考：《宁夏医科大学》2014年硕士论文

【摘要】：目的：探讨3.0T超导体MRI常规序列联合DWI（b=1000s/mm2）对结直肠癌术前T、N分期的价值及病灶、淋巴结ADC值的临床意义。方法：收集2013年6月至11月期间经临床手术病理确诊结直肠癌患者71例。全部病例均行3.0TMRI常规序列及DWI检查。纳入标准：①首诊怀疑结直肠癌患者，或病理证实为结直肠癌；②MRI检查前未经过任何放射性或化学性治疗；③行3.0TMRI检查并采用相同序列；④MRI检查后2周内行手术治疗，并得到肿瘤病灶及淋巴结病理结果。严格按照以上标准进行筛选，最终符合条件的患者57例；其中男性患者39例，女性患者18例，年龄41～81岁，平均为60.17±11.89岁。所以病例采用SIEMENS Skyra3.0T超导MRI，18通道体线圈扫描。患者头先进，行常规T1WI轴位(FOV：360×360mm，矩阵：314×448)、T2WI矢状位（FOV：261×261mm，矩阵：256×320）、冠状位（FOV：401×401mm，矩阵：256×256）、FST2WI轴位（FOV：320×320mm，矩阵：269×384）及DWI轴位（FOV：380×380mm，矩阵：326×384，b=1000s/mm2）。运用SPSS统计软件统计分析3.0TMRI常规序列、常规序列联合DWI对结直肠癌术前T、N分期的准确率、敏感度、特异度、阳性预测值、阴性预测值。采用kappa检验诊断结果的一致性，评估3.0T MRI检查在结直肠癌中应用的价值。测量病灶、转移淋巴结、脂肪间隙转移性结节的ADC值，记录分析有淋巴结和或远处转移的病灶、无转移的病灶的ADC值、转移的淋巴结、脂肪间隙转移性结节的ADC值，采用独立样本t检验，检验水准α=0.05，p0.05有统计学意义。结果：57例病例，MRI常规序列检查T分期的总准确率为87.72%，与病理结果一致性一般，，kappa=0.69；N分期的总准确率为84.21%，与病理结果一致性好，kappa=0.76。MRI常规序列联合DWI检查T分期的总准确率为91.23%，与病理结果一致性好，kappa=0.79；N分期总准确率为78.95%，与病理一致性一般，kappa=0.69。结直肠癌转移组瘤体ADC值小于无转移组，差异有统计学意义(p=0.03)。结论：MRI常规序列联合DWI检查可以提高T分期诊断准确率。测量瘤体、淋巴结ADC值在一定程度上可评估、预测其浸袭性。
[Abstract]:Objective: to evaluate the value of 3T superconductor MRI routine sequence combined with DWI (1000s / m2) in preoperative staging of colorectal cancer and the clinical significance of ADC value of lymph node and lesion. Methods: from June to November, 2013, 71 patients with colorectal cancer confirmed by clinical operation and pathology were collected. All cases were examined by 3.0TMRI routine sequence and DWI. Inclusion Standard: 1 first diagnosed suspected colorectal cancer, or confirmed by pathology that colorectal cancer was diagnosed by 2MRI without any radiotherapeutic or chemotherapeutic 3.0TMRI examination and surgical treatment within 2 weeks after using the same sequence of MRI. The pathological results of tumor focus and lymph node were obtained. According to the above criteria, 57 patients were selected, including 39 male patients and 18 female patients, with an average age of 60.17 卤11.89 years. So the SIEMENS Skyra3.0T superconducting MRI 18 channel body coil scan was used. Patients with advanced head were given routine T1WI axial position FOV: 360 脳 360 mm, matrix: 314 脳 448 / T _ 2WI sagittal position: 261 脳 261 mm, matrix: 256 脳 320m, coronal position FOV: 401 脳 401 mm, matrix 256 脳 256F T _ 2WI axis FOV: 320 脳 320mm, matrix: 269 脳 384) and DWI axis position FOV: 380 脳 380mm, matrix: 326 脳 384s / 1000 s / r ~ 2mm. The accuracy, sensitivity, specificity, positive predictive value and negative predictive value of 3.0TMRI routine sequence combined with DWI in preoperative staging of colorectal cancer were analyzed by SPSS statistical software. The value of 3.0T MRI in colorectal cancer was evaluated by using kappa test to evaluate the consistency of diagnostic results. The ADC values of metastatic nodes, metastatic lymph nodes, fat space metastatic nodules were measured. The ADC values of lymph nodes and distant metastases, non-metastatic lesions, metastatic lymph nodes and fat space metastatic nodules were recorded and analyzed. Using independent sample t test, the test level of 伪 0.05 p 0.05 has statistical significance. Results the total accuracy of T staging by conventional MRI sequence was 87.722.The total accuracy rate of T staging was 84.21 in general agreement with pathological results, and good agreement with pathological results. The total accuracy of DWI combined with conventional MRI sequence was 0.76.The total accuracy rate of T staging was better than that of conventional MRI sequence. The total accuracy of 0.79 N staging was 78.95 and 0.69 with pathological consistency. The ADC value of colorectal cancer metastasis group was lower than that of no metastasis group, the difference was statistically significant. Conclusion the diagnostic accuracy of T-staging can be improved by combining DWI with conventional Mr sequence. The ADC value of lymph node can be evaluated to some extent and its invasion can be predicted.
【学位授予单位】：宁夏医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.2;R735.3

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