摘要
目的探究多参数磁共振成像(MRI)与直肠癌患者临床特征的相关性,并分析多参数MRI各参数联合预测患者预后的价值。方法前瞻性选取2021年2月至2023年1月中国人民解放军联勤保障部队第九八八医院收治的285例直肠癌患者,所有患者均经手术病理确诊,术前接受多模态MRI检查。比较不同临床特征直肠癌患者多参数MRI[表观扩散系数(ADC)、反向回流速率常数(K_(ep))、体积转移常数(K_(trans))、细胞外血管外体积分数(V_(e))],采用Spearman相关系数法分析多参数MRI与直肠癌患者临床特征的相关性。治疗后随访1年统计直肠癌患者复发情况,比较不同预后直肠癌患者的多参数MRI,绘制受试者工作特征(ROC)曲线分析各参数对直肠癌患者预后不良的预测价值。结果T_(2)期直肠癌患者的ADC水平明显高于T3期,T_(2)期患者的K_(ep)、K_(trans)、V_(e)水平明显低于T3期,差异均有统计学意义(P<0.05);高分化直肠癌患者的ADC水平明显高于中分化和低分化患者,且中分化患者的ADC水平高于低分化患者,差异均有统计学意义(P<0.05);高分化直肠癌患者的K_(ep)、K_(trans)、V_(e)水平明显低于中分化和低分化患者,且中分化患者的上述指标均低于中分化患者,差异均有统计学意义(P<0.05);无盆腔淋巴结转移直肠癌患者的ADC水平明显高于盆腔淋巴结转移患者,K_(ep)、K_(trans)、V_(e)水平明显低于盆腔淋巴结转移患者,差异均有统计学意义(P<0.05);Spearman相关系数法分析结果显示,直肠癌患者ADC与T分期、分化程度、盆腔淋巴结转移呈负相关(P<0.05),K_(ep)、K_(trans)、V_(e)与T分期、分化程度、盆腔淋巴结转移呈正相关(P<0.05);预后良好组患者的ADC水平明显高于预后不良组,K_(ep)、K_(trans)、V_(e)水平明显低于预后不良组,差异均有统计学意义(P<0.05);K_(ep)、K_(trans)、V_(e)、ADC联合预测直肠癌患者预后不良的AUC为0.907(95%CI:0.866~0.938),优于各参数单一预测(P<0.05)。结论多参数MRI与直肠癌患者T分期、分化程度、盆腔淋巴结转移密切相关,联合多参数MRI预测直肠癌患者预后有较高的临床价值。
Objective To investigate the correlation between multiparametric magnetic resonance imaging(MRI)and clinical characteristics of rectal cancer patients,and to analyze the predictive value of combined multiparametric MRI parameters for prognosis.Methods A prospective study was conducted on 285 rectal cancer patients admitted to No.988 Hospital of Joint Logistic Support Force of Chinese People's Liberation Army from February 2021 to January 2023.All patients were pathologically confirmed and underwent multiparametric MRI before surgery.Multiparametric MRI parameters(apparent diffusion coefficient[ADC],reverse reflux rate constant[K_(ep)],volume transfer constant[K_(trans)],and extracellular extravascular volume fraction[V_(e)])were compared among patients with different clinical characteristics.Spearman correlation analysis was used to evaluate the relationship between multiparametric MRI and clinical features.Patients were followed up for 1 year post-treatment to assess recurrence.Multiparametric MRI parameters were compared between patients with different prognoses,and receiver operating characteristic(ROC)curves were plotted to analyze the predictive value of each parameter for poor prognosis.Results ADC values were significantly higher in T_(2)-stage patients than in T3-stage patients(P<0.05),while K_(ep),K_(trans),and V_(e) levels were significantly lower in T_(2)-stage patients(P<0.05).Well-differentiated tumors showed significantly higher ADC values than moderately and poorly differentiated tumors(P<0.05),with moderately differentiated tumors having higher ADC than poorly differentiated ones(P<0.05).Conversely,K_(ep),K_(trans),and V_(e) levels were significantly lower in well-differentiated tumors(P<0.05).Patients without pelvic lymph node metastasis had significantly higher ADC and lower K_(ep),K_(trans),and V_(e) levels than those with metastasis(P<0.05).Spearman analysis revealed that ADC was negatively correlated with T-stage,differentiation degree,and lymph node metastasis(P<0.05),while K_(ep),K_(trans),and V_(e) showed positive correlations(P<0.05).The favorable prognosis group had significantly higher ADC and lower K_(ep),K_(trans),and V_(e) levels than the poor prognosis group(P<0.05).The combined prediction of K_(ep),K_(trans),V_(e),and ADC for poor prognosis yielded an AUC of 0.907(95%CI:0.866-0.938),outperforming individual parameters(P<0.05).Conclusion Multiparametric MRI is closely associated with T-stage,tumor differentiation,and pelvic lymph node metastasis in rectal cancer.The combined use of multiparametric MRI parameters holds significant clinical value for predicting patient prognosis.
作者
于联芳
张东显
李光景
丁科
游波涛
YU Lian-fang;ZHANG Dong-xian;LI Guang-jing;DING Ke;YOU Bo-tao(Department of Imaging Medicine,No.988 Hospital of Joint Logistic Support Force of Chinese People's Liberation Army,Zhengzhou 450000,Henan,CHINA;Department of Emergency Medicine,No.988 Hospital of Joint Logistic Support Force of Chinese People's Liberation Army,Zhengzhou 450000,Henan,CHINA)
出处
《海南医学》
2025年第15期2215-2220,共6页
Hainan Medical Journal
基金
河南省医学科技攻关计划联合共建项目(编号:LHGJ20220923)。
关键词
直肠癌
多参数磁共振成像
表观扩散系数
反向回流速率常数
体积转移常数
细胞外血管外体积分数
预后
预测价值
Rectal cancer
Multiparametric magnetic resonance imaging
Apparent diffusion coefficient
Reverse reflux rate constant
Volume transfer constant
Extracellular extravascular volume fraction
Prognosis
Predictive value
作者简介
第一作者:于联芳(1981-),男,主治医师,主要研究方向为磁共振诊断;通讯作者:游波涛(1982-),男,主治医师,主要研究方向为CT、MR诊断,E-mail:13838543856@139.com。
