磁共振成像在直肠癌术前分期诊断中的应用及ADC值与直肠腺癌分化程度间的相关性研究

发布时间：2018-05-20 17:37

本文选题：开塞露 + 直肠癌　；参考：《北京协和医学院》2014年硕士论文

【摘要】：第一部分开塞露在直肠癌MRI术前T1和T2分期中的应用目的：探讨使用开塞露进行肠道准备对直肠磁共振术前T1分期和T2分期的意义。材料与方法：回顾性收集2005年9月至2013年12月北京协和医院经活检病理证实为直肠癌、行术前MRI检查(2周)并经手术病理证实为T1或T2分期直肠癌的患者81例,男51例,女30例,平均年龄64.2±12.2岁(31～88岁)。其中,2012年6月至2013年12月患者45例,男30例,女15例,平均年龄63.4±13.7岁(31-82岁)使用开塞露；2005年9月至2012年5月患者36例,男21例,女15例,平均年龄65.6±11.5岁(35～88岁),未使用开塞露。患者全部签署知情同意书；然后分别将两组(使用开塞露组和未用开塞露组)的术后病理分期结果与术前MR分期结果进行对照分析,分别计算直肠癌磁共振T1、T2分期的敏感度、特异度、准确度、阳性预测值、阴性预测值和T1+T2分期的敏感度；并采用Kappa检验,分析两组MRI术前分期与病理分期结果的一致性。结果：采用Kappa检验,经统计分析证实两组MRI术前分期与病理分期结果的一致性均为中等,k值分别为使用开塞露组0.693,未用开塞露组0.537。使用开塞露组直肠癌磁共振T分期的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为T1分期：76.5%、92.9%、86.7%、86.7%、86.7%；T2分期：78.6%、76.5%、86.7%、84.5%、68.4%。T1+T2分期的敏感度为：77.8%。未使用开塞露组直肠癌磁共振T分期的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为T1分期：57.1%、95.5%、80.6%、88.9%、77.8%；T2分期：77.3%、57.1%、69.4%、73.9%、61.5%。T1+T2分期的敏感度为：69.4%。通过统计分析证实使用开塞露组T1分期的敏感度及T2分期特异度、准确度高于未使用开塞露组(P0.05,单侧)。结论：使用开塞露进行肠道准备能够提高直肠癌磁共振T1分期的敏感度、T2分期特异度及准确度,同时在一定程度上提高T1和T2分期的诊断准确性,建议作为直肠癌磁共振检查的肠道准备常规应用。第二部分3T和1.5T MRI在直肠癌术前肠周脂肪侵润诊断中应用的比较研究目的：比较3T和1.5T MRI在直肠癌术前肠周脂肪侵润诊断中的应用价值。材料与方法：回顾性收集北京协和医院2012年5月至2014年2月,经活检病理证实为直肠癌、行术前MRI检查(2周)并经手术病理证实为T2或T3分期的患者79例,男49例,女30例,平均年龄65.3±11.6岁(32-87岁)。其中,2013年5月至2014年2月行3T磁共振检查患者29例(男16例,女13例),平均年龄64.7±11.3岁(32-81岁)；2012年5月至2014年2月行1.5T磁共振检查患者50例(男33例,女17例),平均年龄65.5±11.8岁(34-87岁)。患者全部签署知情同意书。然后分别将两组(3T MRI组和1.5T MRI组)的术后病理分期结果与术前MR分期结果进行对照,分别计算直肠癌磁共振有/无肠周脂肪侵润(T3/T2分期)的敏感度、特异度、准确度、阳性预测值、阴性预测值；采用Kappa检验,分析两组MRI术前分期与术后病理分期结果的一致性。结果：统计分析证实两组术前MRI分期与术后病理分期结果的一致性均为中等,K值分别为3T MRI组0.712,1.5T MRI组0.689。3T MRI组直肠癌磁共振有/无肠周脂肪侵润的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为无肠周脂肪侵润(T2期)：90.9%、94.4%、93.1%、90.9%和94.4%；有肠周脂肪侵润(T3期)：94.4%、90.9%、93.1%、94.4%和90.9%。1.5T MRI组分别为无肠周脂肪侵润(T2期)：71.4%、81.8%、76.0%、83.3%和69.2%；有肠周脂肪侵润(T3期)：81.8%、78.6%、80.0%、75.0%和84.6%。通过统计分析证实3T MRI组有/无肠周脂肪侵润(T3/T2分期)的敏感度、特异度、准确度、阳性预测值、阴性预测值均高于1.5T MRI组(P(0.05,单侧)。结论：与1.5T相比,3T磁共振能够提高诊断直肠癌有/无肠周脂肪侵润(T3/T2期)的准确性,对直肠磁共振T3和T2分期有较高的价值。本文中提出的直肠癌MRI局部浸润征象的诊断参考标准具有一定的应用价值。第三部分ADC值与直肠腺癌分化程度间的相关性研究目的：探讨ADC值与直肠黏液腺癌、不同分化程度的直肠腺癌间的关系。材料与方法：收集2012年5月至2014年2月北京协和医院经活检病理证实为直肠癌、行术前MRI检查(2周)并经手术病理证实为直肠黏液腺癌或不同分化程度的直肠腺癌的患者88例,男51例,女37例,平均年龄65.8±13.1岁(35～87岁)。其中,直肠黏液腺癌9例,占10.2%,直肠腺癌79例,高分化(包括中-高分化13例)、中分化、低分化分别为31、40和8例。患者全部签署知情同意书。所有患者均行DWI扫描(b=1000),并在工作站上测出病灶ADC值,然后分别将黏液腺癌组和全部腺癌组的ADC值进行比较；将黏液腺癌组和腺癌高分化、中分化、低分化组的ADC值进行两两比较,并分析ADC值在不同病理类型及分化程度直肠癌中的差异。结果：直肠黏液腺癌组、全部腺癌组、腺癌高分化、中分化、低分化组的平均ADC值分别为(1.362±0.124)×10q-3mm2/s、(0.949±0.146).(1.129±0.128)×10-3mm2/s、(0.865±0.143)×10-3mm2s、(0.672±0.196)×10-3mm2/s,通过统计分析证实黏液腺癌组和全部腺癌组ADC值的差异具有统计学意义(P0.05),黏液腺癌组的ADC值高于腺癌组；黏液腺癌组与腺癌高、中、低分化组ADC值两两间差异均具有统计学意义(P0.05),黏液腺癌组的ADC值高于腺癌高、中、低分化组；并且腺癌ADC值随肿瘤分化程度的升高而升高。结论：ADC值有助于鉴别直肠黏液腺癌与不同分化程度的直肠腺癌,ADC值与直肠腺癌分化程度呈正相关。
[Abstract]:Part one application of Enema Glycerini in T1 and T2 staging of rectal cancer before MRI operation
Objective: To investigate the significance of Enema Glycerini preparation for bowel preparation in preoperative T1 staging and T2 staging of rectal magnetic resonance.
Materials and methods: a retrospective collection of 81 cases of rectal cancer confirmed by biopsy by biopsy in Peking Union Medical College Hospital from September 2005 to December 2013, with preoperative MRI examination (2 weeks) and T1 or T2 staging rectal cancer confirmed by operation and pathology, 51 males and 30 females, with an average age of 64.2 + 12.2 years (31~88 years). Among them, 45 cases were from June 2012 to December 2013. 30 men and 15 women, with an average age of 63.4 + 13.7 years (31-82 years old) using Enema Glycerini; 36 cases, 21 men and 15 women from September 2005 to May 2012, average age 65.6 + 11.5 years (35~88 years old), not using Enema Glycerini. Patients were all signed informed consent; then the postoperative pathology of the two group (using the Enema Glycerini group and the unused Enema Glycerini group) was followed by the postoperative pathology. The staging results were compared with the results of preoperative MR staging, and the sensitivity, specificity, accuracy, positive predictive value, negative predictive value and T1+T2 staging of rectal cancer T1, T2 staging, and the sensitivity of negative predictive value and T1+T2 staging were calculated respectively, and the consistency between the two groups of preoperative staging and pathological staging was analyzed by Kappa test.
Results: by Kappa test, the statistical analysis showed that the consistency of the two groups of MRI preoperative staging and pathological staging were all moderate, K value was 0.693 in Enema Glycerini group, and the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the Enema Glycerini group 0.537. were not used for the T staging of rectal cancer in the group of Enema Glycerini. The negative predictive values were T1 points, respectively. Period: 76.5%, 92.9%, 86.7%, 86.7%, 86.7%; T2 staging: the sensitivity of the 78.6%, 76.5%, 86.7%, 84.5%, and 68.4%.T1+T2 staging: the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of the 77.8%. staging of rectal cancer in the Enema Glycerini group were T1 staging, 57.1%, 95.5%, 80.6%, 88.9%, 77.8%; T2 staging, respectively, The sensitivity of 69.4%, 73.9%, 61.5%.T1+T2 staging was: 69.4%. by statistical analysis proved that the sensitivity of T1 staging and the specificity of T2 staging were used in Enema Glycerini group, and the accuracy was higher than that of the unused Enema Glycerini group (P0.05, unilateral).
Conclusion: the use of Enema Glycerini for intestinal preparation can improve the sensitivity of MRI T1 staging of rectal cancer, the specificity and accuracy of T2 staging, and improve the diagnostic accuracy of T1 and T2 staging to a certain extent. It is recommended to be used as the routine application of the bowel preparation for rectal cancer magnetic resonance examination.
The second part is a comparative study of 3T and 1.5T MRI in the diagnosis of preoperative peri intestinal fat infiltration in rectal cancer.
Objective: To compare the diagnostic value of 3T and 1.5T MRI in preoperative peri intestinal fat infiltration in rectal cancer.
Materials and methods: a retrospective collection of Peking Union Medical College Hospital from May 2012 to February 2014, with biopsy pathology confirmed rectal cancer, preoperative MRI examination (2 weeks) and 79 cases of T2 or T3 staging confirmed by surgery and pathology, 49 males and 30 females, with an average age of 65.3 + 11.6 years (32-87 years). Among them, 3T MRI was performed from May 2013 to February 2014. 29 cases (male 16, female 13), the average age of 64.7 + 11.3 years (32-81 years); from May 2012 to February 2014, 50 patients (33 men, 17 cases) and average age 65.5 + 11.8 years (34-87 years old) were performed by 1.5T MRI. The patients were all signed informed consent. Then the postoperative pathological staging results of the two group (group 3T MRI and 1.5T MRI) were compared with preoperative MR respectively. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of rectal cancer / T3/T2 staging (T3/T2 staging) were calculated by staging results, and the results of preoperative staging and postoperative pathological staging of two groups were analyzed by Kappa test.
Results: the statistical analysis showed that the consistency of preoperative MRI staging and postoperative pathological staging were all moderate, and the K value was the sensitivity, specificity, accuracy, positive predictive value and negative predictive value of 0.712,1.5T MRI group 0.689.3T MRI in group 3T MRI group 0.689.3T MRI, respectively, without enteral fat invasion (T2 stage), respectively. 90.9%, 94.4%, 93.1%, 90.9%, and 94.4%; group:94.4%, 90.9%, 93.1%, 94.4%, and 90.9%.1.5T MRI of perienteral fat invasion (T2 phase):71.4%, 81.8%, 76%, 83.3% and 69.2%, respectively, with periac fat invasion (T3 phase):81.8%, 78.6%, 80%, and 84.6%. through statistical analysis to confirm that 3T MRI group had / without intestinal lipid. The sensitivity, specificity, accuracy, positive predictive value and negative predictive value of fat infiltration (T3/T2 staging) were higher than those of 1.5T MRI group (P (0.05, unilateral).
Conclusion: compared with 1.5T, 3T MRI can improve the accuracy of diagnosis of rectal cancer / perienteral fat invasion (T3/T2 phase). It is of high value for rectal MRI T3 and T2 staging. The diagnostic reference standard for local invasion of rectal cancer in this paper is of certain value.
The third part is the correlation between ADC value and the differentiation degree of rectal adenocarcinoma.
Objective: To investigate the relationship between ADC and rectal mucinous adenocarcinoma and rectal adenocarcinoma with different degree of differentiation.
Materials and methods: 88 cases of rectal mucinous adenocarcinoma or different degree of rectal adenocarcinoma confirmed by preoperative MRI examination (2 weeks) and 88 cases of rectal adenocarcinoma with different degrees of differentiation were confirmed by biopsy of the Peking Union Medical College Hospital from May 2012 to February 2014. The rectal mucous glands of the rectum were 65.8 + 13.1 years old (35~87 years). 9 cases were cancer, 79 cases of rectal adenocarcinoma, high differentiation (including middle and high differentiation 13 cases), middle differentiation, low differentiation 31,40 and 8 cases. All patients signed informed consent. All patients underwent DWI scan (b=1000), and the ADC value of the lesion was measured on the workstation. Then the ADC value of mucous adenocarcinoma group and all adenocarcinoma group was compared, and the viscosity of the mucous adenocarcinoma group was compared. The ADC values of the high differentiation, middle differentiation, and low differentiation group were compared in the liquid adenocarcinoma group and the adenocarcinoma group, and the difference in the ADC value in the different pathological types and the differentiation degree of the rectal cancer was analyzed.
Results: the average ADC value of all adenocarcinoma group, all adenocarcinoma group, high differentiation, middle differentiation and low differentiation group was (1.362 + 0.124) x 10q-3mm2/s, (0.949 + 0.146). (1.129 + 0.128) x 10-3mm2/s, (0.865 + 0.143) x 10-3mm2s and (0.672 + 0.196) x 10-3mm2/s. The difference of ADC value between mucous adenocarcinoma group and all adenocarcinoma group was confirmed by statistical analysis. The difference was statistically significant (P0.05). The value of ADC in the mucous adenocarcinoma group was higher than that in the adenocarcinoma group, and the 22 differences between the mucous adenocarcinoma group and the adenocarcinoma, middle and low differentiation group were all statistically significant (P0.05). The ADC value of the mucous adenocarcinoma group was higher than that of the adenocarcinoma, middle and low differentiation group, and the ADC value of adenocarcinoma increased with the increase of the degree of tumor differentiation.
Conclusion: ADC is helpful in differentiating rectal mucinous adenocarcinoma from rectal adenocarcinoma with different degree of differentiation. ADC is positively correlated with the differentiation degree of rectal adenocarcinoma.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R735.37;R445.2

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