磁共振弥散峰度成像在直肠癌诊断中的应用研究

发布时间：2018-08-23 11:45

【摘要】：目的：探讨磁共振弥散峰度成像(Diffusional Kurtosis Imaging DKI)在直肠癌诊断中的价值 材料与方法：对2013年7月至2014年2月就诊我院128例直肠疾病患者行常规MRI扫描及DKI扫描，检查后28例患者2周内直接行手术治疗。扫描采用5个B值（0,500,1000,1500,2000sec/mm2），3个扩散梯度场。图像通过Permeability软件处理后获得病变及正常肠壁DKI参数：平均表观弥散系数MD以及平均峰度系数MK。所有数据应用SPSS19.0统计软件进行分析。 结果：28例患者中，中分化腺癌20例、低分化腺癌1例、粘液腺癌3例、腺瘤1例、炎症3例。直肠癌MD及MK平均值分别为1.30±0.27×10-3mm2/sec,1.07±0.16，炎症的参数值分别为1.63±0.07×10-3mm2/sec，0.84±0.05，而正常肠壁的参数值分别为1.81±0.35×10-3mm2/sec,0.83±0.21。肿瘤和正常肠壁，肿瘤与炎症，中分化腺癌与粘液腺癌间MD值与MK值差异有统计学意义（p0.05）。诊断直肠癌MD值及MK值的受试者ROC曲线下的面积均较高，分别为0.907及0.849。以MD值≤1.446×10-3mm2/sec作为诊断直肠癌的阈值时，其诊断的敏感性为92%,特异性为79%；以MK值≥0.908作为诊断直肠癌的阈值时，敏感性为83%，特异性68%。诊断中分化腺癌MD值与MK值ROC曲线下面积分别为0.857及0.889；以MD值≤1.263×10-3mm2/sec作为诊断中分化腺癌阈值时，敏感性为100%，特异性为57%，MK值≥0.958作为诊断中分化腺癌阈值时，，敏感性为86%，特异性为67%。DK参数在正常肠壁及炎症间、有无淋巴结转移直肠癌患者间、各不同术后TNM及Dukes分期间无显著统计学差异（p0.05）。直肠癌DK-MRI参数与术后标本T分期、N分期、病理分期、DUKES分期间无显著相关。结论：初步研究发现DKI参数具有鉴别正常肠壁、炎症与腺癌的潜力，能够反映直肠癌微观结构的复杂性。
[Abstract]:Objective: to evaluate the value of (Diffusional Kurtosis Imaging DKI) in the diagnosis of rectal cancer: from July 2013 to February 2014, 128 patients with rectal diseases in our hospital underwent routine MRI and DKI scans. After examination, 28 patients underwent direct surgical treatment within 2 weeks. The scan was performed with 5 B values (0 / 500 / 1000 / 1500 / 2000 sec-mm2) and 3 diffusion gradient fields. The DKI parameters of lesion and normal intestinal wall were obtained by Permeability software. The mean apparent diffusion coefficient (MD) and the mean kurtosis coefficient (MK) were obtained. All data were analyzed by SPSS19.0 statistical software. Results among 28 patients, 20 cases were moderately differentiated adenocarcinoma, 1 case was poorly differentiated adenocarcinoma, 3 cases were mucinous adenocarcinoma, 1 case was adenoma and 3 cases were inflammation. The mean values of MD and MK in rectal cancer were 1.30 卤0.27 脳 10 ~ (-3) mm ~ (-2) / secg ~ (2) and 1.07 卤0.16, respectively. The parameters of inflammation were 1.63 卤0.07 脳 10 ~ (-3) mm ~ (-2) / sec0.84 卤0.05 respectively, while those of normal intestinal wall were 1.81 卤0.35 脳 10 ~ (-3) mm ~ (-2) / sec0.83 卤0.21 respectively. There were significant differences in MD and MK between tumor and normal intestinal wall, tumor and inflammation, middle differentiated adenocarcinoma and mucinous adenocarcinoma (p0.05). The area under the ROC curve of the subjects diagnosed with MD and MK were 0.907 and 0.849, respectively. When the threshold value of MD 鈮

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