MR体素内不相干运动扩散加权成像对直肠腺癌T分期及分化程度的应用价值研究

目的通探讨体素内不相干运动扩散加权成像(intravoxel incoherent motion diffusion weighted imaging,IVIM-DWI)各定量参数值对直肠腺癌分期、分化程度的应用价值。材料与方法采用GE3.0 T MR扫描仪获得48例经肠镜证实为直肠腺癌患者术前影像学资料,并收集患者术后病理资料(单纯腺癌42例,腺癌伴部分粘液腺癌6例)。利用GE AW4.5工作站对图像进行后处理,获得单纯直肠腺癌不同分期、分化程度的表观扩散系数(apparent diffusion coefficient,ADC)、单纯扩散系数(D)、灌注相关扩散系数(D*)和灌注分数(f)值。直肠腺癌不同分期、分化程度间各参数应用ANOVA,组间两两比较采用LSD法。结果 ADC及D在直肠腺癌不同T分期及分化程度之间差异均有统计学意义,T2-T4期直肠腺癌的ADC值分别为(1.200±0.117)×10~(-3))mm~2/s、(0.913±0.104)×10~(-3) mm~2/s、(0.786±0.450)×10~(-3) mm~2/s,D值分别为(0.737±0.055)×10~(-3) mm~2/s、(0.608±0.091)×10~(-3) mm~2/s、(0.593±0.041)×10~(-3) mm~2/s,高-低分化直肠腺癌的ADC值分别为(1.353±0.080)×10~(-3) mm~2/s、(0.984±0.028)×10~(-3) mm~2/s、(0.8 0 8±0.0 7 5)×1 0~(-3) mm~2/s,D值分别为(0.805±0.085)×1 0~(-3) mm~2/s、(0.645±0.081)×10~(-3) mm~2/s、(0.525±0.057)×10~(-3) mm~2/s,D*和f值在直肠腺癌不同T分期及分化程度之间差异无统计学意义。结论直肠腺癌病灶的ADC、D值可在一定程度上反映肿瘤分期、分化特点,IVIM-DWI作为常规MR的补充序列,为临床最佳治疗方案的选择提供更多信息支持。

The value of MR intravoxel incoherent motion diffusion weighted imaging in T stage and differentiated degree of rectal adenocarcinoma

Objective:To investigate the value of intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI) quantitative parameters in T stage and differentiated degree of rectal adenocarcinoma.Materials and Methods:Fourty-eight cases of rectal adenocarcinoma confirmed by colonoscopy underwent 3.0 T MR examination,their clinicopathologic data were collected (42 cases were pure adenocarcinoma, 6 cases were adenocarcinoma with partial mucinous adenocarcinoma). GE AW4.5 workstation was used to calculate the value of ADC, D, D* and f of various T stages and differentiated degree. All parameters of various T stages and differentiated degree were compared by ANOVA and comparison between the two groups by LSD.Results:The ADC and D value in various T stage and in various degrees of differentiation were all statistically significant, for rectal adenocarcinoma of T2-T4, the value of ADC were (1.200±0.117)×10-3 mm2/s, (0.913±0.104)× 10-3 mm2/s, (0.786±0.450)×10-3 mm2/s, The value of D were (0.737±0.055)×10-3 mm2/s, (0.608±0.091)×10-3 mm2/s, (0.593±0.041)×10-3 mm2/s, the value of ADC in high, medium and low differentiation were (1.353±0.080)×10-3 mm2/s, (0.984±0.028)×10-3 mm2/s, (0.808±0.075)×10-3 mm2/s respectively, the value of D in high, medium and low differentation were (0.805±0.085)×10-3 mm2/s, (0.645±0.081)×10-3 mm2/s,(0.525±0.057)×10-3 mm2/s, D* and f value were no signiifcant difference.Conclusion:ADC and D value are able to relfect T stage and differentiation features of rectal adenocarcinoma, IVIM-DWI can serve as a complement sequence for conventional MR sequences, can provide more information to choose the best treatment.