摘要
目的探讨高分辨T_(2)加权成像(HR-T_(2)WI)联合扩散加权成像(DWI)鉴别肠壁内外直肠腺癌的价值。方法选择术前行HR-T_(2)WI和DWI检查并经手术病理诊断证实的直肠腺癌患者92例,其中男性61例,女性31例;年龄39~87岁,平均年龄66.82岁;其中黏液腺癌12例;隆起型41例,溃疡型51例。甲乙医师分别对HR-T_(2)WI、HR-T_(2)WI联合DWI图像进行分析,做出肠壁内或肠壁外直肠腺癌的诊断。Kappa分析操作者间一致性;采用受试者工作特性(ROC)曲线分析HR-T_(2)WI、HR-T_(2)WI联合DWI鉴别肠壁内外直肠腺癌的诊断效能;采用Delong检验比较曲线下面积(AUC)。结果术后病理诊断结果:T1期4例,T_(2)期32例,T3期51例,T4期5例,T1和T_(2)期为肠壁内组(36例),T3和T4期为肠壁外组(56例)。甲乙医师HR-T_(2)WI诊断T1、T2、T3、T4期直肠腺癌正确例数分别依次为2/4例、2/4例,17/32例、19/32例,40/51例、38/51例,4/5例、4/5例;HR-T_(2)WI联合DWI正确例数分别依次为2/4例、2/4例,28/32例、29/32例,48/51例、48/51例,5/5例、4/5例。甲乙医师采用HR-T_(2)WI、HR-T_(2)WI联合DWI鉴别肠壁内外直肠腺癌的一致性均较高,Kappa值分别为0.757、0.909。甲乙医师运用HR-T_(2)WI诊断肠壁内外直肠腺癌价值中等,AUC分别为0.720、0.753;甲乙医师运用HR-T_(2)WI联合DWI诊断肠壁内外直肠腺癌价值较高,AUC分别为0.932、0.954。甲乙医师运用HR-T_(2)WI联合DWI的诊断效能高于单独运用HR-T_(2)WI,差异均有显著统计学意义(P<0.001)。结论HR-T_(2)WI联合DWI鉴别肠壁内外直肠腺癌,读片者间一致性和诊断效能优于单独使用HR-T_(2)WI。
Objective To investigate the value of high resolution T_(2)-weight imaging(HR-T_(2)WI)combined diffusion weighted imaging(DWI)in identifying rectal cancer exterior and interior intestinal wall.Methods A total of 92 patients with rectal cancer performed preoperative HR-T_(2)WI and DWI examination and confirmed by surgery and pathology were enrolled,which included 61 males and 31 females,aged 39-87 years old and mean age of 66.82 years old.Twelve cases were mucinous adenocarcinoma;41 cases of bulging type and 51 of ulcer type.HR-T_(2)WI and HR-T_(2)WI combined DWI images were analyzed to diagnose rectal adenocarcinoma in exterior and interior intestinal wall by physicians A and B,respectively.Kappa was used to analyze interoperator consistency,receiver operating characteristic(ROC)curve was used to analyze the diagnostic performance of HR-T_(2)WI,HR-T_(2)WI combined DWI in differentiating rectal cancer exterior and interior intestinal wall.Delong test was used to compare area under the curve(AUC).Results Postoperative pathological diagnosis results showed that 4 cases was T1 stage,32 of T_(2)stage,51 of T3 stage,5 of T4 stage,T1 and T_(2)stage were interior intestinal wall group(n=36),T3 and T4 stage were exterior intestinal wall group(n=56).The correct rectal cancer cases number of T1,T2,T3 and T4 diagnosed by physicians A and B by HR-T_(2)WI was 2/4 cases,2/4 cases,17/32 cases,19/32 cases,40/51 cases,38/51 cases,4/5 cases and4/5 cases,respectively;the number of correct cases by HR-T_(2)WI combined DWI was 2/4 cases,2/4 cases,28/32 cases,29/32cases,48/51 cases,48/51 cases,5/5 cases and 4/5 cases,respectively.Physicians A and B showed high consistency in HR-T_(2)WI and HR-T_(2)WI combined DWI to identify rectal cancer exterior and interior intestinal wall,Kappa value was 0.757 and0.909,respectively.Physicians A and B used HR-T_(2)WI to diagnose rectal cancer exterior and interior intestinal wall in moderate value,AUC value was 0.720 and 0.753,respectively.Physicians A and B used HR-T_(2)WI combined DWI to diagnose rectal cancer exterior and interior intestinal wall in high value,AUC value was 0.932,0.954.The diagnostic performance of HR-T_(2)WI combined DWI was significantly higher than that of HR-T_(2)WI,and the difference was statistically significant(P<0.001).Conclusion It is demonstrated that HR-T_(2)WI combined DWI could identify rectal cancer exterior and interior intestinal wall,and the physician consistency as well as diagnostic performance are better than HR-T_(2)WI.
作者
过永
杜涛
张晓金
张祥
齐东华
张虎
GUO Yong;DU Tao;ZHANG Xiao-jin;ZHANG Xiang;QI Dong-hua;ZHANG Hu(Department of Medical Imaging,Wuhu Second People’s Hospital,Wuhu 241000,Anhui,China)
出处
《生物医学工程与临床》
CAS
2022年第6期743-747,共5页
Biomedical Engineering and Clinical Medicine
作者简介
过永(1990-),男,安徽蒙城人,硕士,主治医师,主要从事腹部影像学研究。E-mail:1443458743@qq.com;通信作者:张虎(1983-),男,安徽芜湖市人,硕士,主治医师,主要从事腹部影像学研究。电话:0553-3909219。E-mail:m18055373782@163.com。
