Applications of quantitative and semi-quantitative dynamic contrast enhanced magnetic resonance imaging analysis in T-staging and N-staging of preoperative rectal cancer
Yang Xiaotang*, Zhang Jianxin, Du Xiaosong, Hou Lina, Huang Ning.
*Department of Radiology, Shanxi Province Tumor Hospital, Taiyuan 030000, China
摘要目的 评估动态增强MRI(DCE-MRI)定量、半定量分析在直肠癌术前T、N分期诊断中的应用价值。方法 回顾性分析山西省肿瘤医院MR室2014年7月—2014年11月经肠镜病理证实的27 例直肠癌患者影像资料。其中男18例,女9例,年龄45～73岁,此前均未经任何治疗。均于术前行DCE-MRI,用Omni-Kinetics专用灌注软件进行后处理,同时获得容量转移常数(Ktrans)、速率常数(Kep)、细胞外血管外间隙容积比(Ve)等定量参数,以及达峰时间(TTP)、曲线下面积(AUC)、最大浓度(Max Conc)、最大斜率(Max Slope)等半定量参数。对正常肠壁与病变段肠壁的定量、半定量参数行独立样本t检验;采用秩和检验比较各定量、半定量参数在直肠癌术后病理T、N分期的差异,判断各参数的诊断价值。应用ROC曲线分析定量参数在T、N分期中的最佳诊断界点及敏感性、特异性。根据TNM对患者进行分期。结果 正常肠壁与病变段肠壁的Ktrans值[(0.28±0.14)min-1 vs (1.33±0.86)min-1]、Kep值[(1.41±0.67)min-1 vs (3.56±0.72)min-1]、Max Conc(0.17±0.02 vs 0.29±0.09)、AUC(0.11±0.07 vs 0.23±0.11)比较,差异均具有统计学意义(t=-6.270、-11.359、-2.487、-2.803,P值均＜0.05)。在T分期为T1～2的早期组与T3～4的晚期组间Ktrans值[0.66(0.12～1.35)min-1 vs 2.15(0.84～2.96) min-1]、Kep值[2.51(0.12～5.65)min-1 vs 4.05(3.18～6.68) min-1]比较,差异均有统计学意义(Z值分别为-4.077、-2.281,P值均＜0.05)。N分期中,淋巴结无转移组的Ktrans值(1.01±0.73)、Ve值(0.29±0.18)、TPP(0.93±0.35)均低于转移组(1.75±0.84、0.54±0.29、1.14±0.15,差异均有统计学意义(Z值分别为-2.433、-2.832、-2.496,P值均＜0.05)。结论 DCE-MRI定量及半定量参数在判断正常肠壁与病变段肠壁、直肠癌的术前T、N分期方面和病理有较高的相关性,对诊断有一定参考价值。定量参数Ktrans值、Ve值最佳诊断界点为直肠癌T、N分期提供了较高的敏感性与特异性。
Abstract：Objective To explore diagnostic values of the semi-quantitative and quantitative dynamic contrast enhanced magnetic resonance imaging(DCE-MRI) analysis in the T-stage and N-stage preoperative assessment of rectal cancer.Methods Twenty-seven patients with colonoscopy pathologically proven rectal cancer in Shanxi Province Tumor Hospital from July 2014 to Nov. 2014 were retrospectively analyzed. Among those, there were 18 men and 9 women, ages ranged from 45 to 73 years, and no prior surgeries were performed. The patients underwent DCE-MRI examinations before the surgery, with several semiquantitative and quantitative parameters including transfer constant(Ktrans), rate constant of bacKflux(Kep) , extravascular extracellular volume fraction(Ve), Time To Peak(TTP), Max Concentration, Area Under Curve(ADC) and Max Slope measured and statistically analyzed using Omni-Kinetics software. Differences of the quantitative and semiquantitative parameters between normal tissue and lesions were compared using the paired t test. Mann-whitney U tests were utilized to examine the differences of the quantitive and semiquantitative parameters between different T-stage or N-stage lesions to determine their diagnostic values. Receiver operating characteristic (ROC) curve analyses were performed to determine the cut-off values to quantitatively distinguish different T stages and N stages.Results There were significant differences of Ktrans, Kep, Max Conc and AUC between normal tissue and lesions (t=-6.270, -11.359, -2.487, -2.803, all P values＜0.05). In T-staging, Ktrans and Kep values were statistically significant between T1-2 group and T3-4 group (Z=-4.077, -2.281, all P values＜0.05). In N-staging, the Ktrans, Ve and TTP in no lymph node metastasis group was significantly lower than those in lymph node metastasis group (Z=-2.433, -2.832, -2.496, all P values＜0.05).Conclusions The quantitative and semi-quantitative DCE-MRI parameters showed high correlations with pathology in differentiation of normal rectal wall and lesions, and in preoperative rectal cancer T-staging and N-staging, which demonstrated reference values in diagnosis. The cut-off value of Ktrans and Ve values provided high sensitivity and specificity in differentiation between T staging and N staging.
杨晓棠, 张建新, 杜笑松, 侯丽娜, 黄宁. 动态增强MRI定量与半定量分析在直肠癌术前T、N分期中的应用价值[J]. 中华解剖与临床杂志, 2016, 21(2): 109-114.
Yang Xiaotang, Zhang Jianxin, Du Xiaosong, Hou Lina, Huang Ning.. Applications of quantitative and semi-quantitative dynamic contrast enhanced magnetic resonance imaging analysis in T-staging and N-staging of preoperative rectal cancer. Chinese Journal of Anatomy and Clinics, 2016, 21(2): 109-114.
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2016, Vol. 21 
