中华胃肠外科杂志
中華胃腸外科雜誌
중화위장외과잡지
CHINESE JOURNAL OF GASTROINTESTINAL SURGERY
2011年
11期
859-863
,共5页
王莉莉%段青%薛蕴箐%黄新明%王承胜%孙斌
王莉莉%段青%薛蘊箐%黃新明%王承勝%孫斌
왕리리%단청%설온정%황신명%왕승성%손빈
直肠肿瘤,复发%磁共振成像,弥散%三维容积内插屏气检查
直腸腫瘤,複髮%磁共振成像,瀰散%三維容積內插屏氣檢查
직장종류,복발%자공진성상,미산%삼유용적내삽병기검사
Rectal neoplasms,recurrence%Magnatic resonance imaging,diffusion%3D-VIBE
目的 评价3.0 T MR的T2加权成像(T2WI)、弥散加权成像(DWI)和三维容积内插屏气检查(3D-VIBE)在直肠癌术后肿瘤复发与良性病变鉴别诊断中的应用价值.方法 回顾性分析福建医科大学附属协和医院2007年4月至2010年10月经MR检出的28例直肠癌术后病变患者的MR影像资料,28例患者均接受T2WI序列和DWI序列检查,其中有24例接受3D-VIBE序列检查.选取13例同时期因盆腔其他病变行MR扫描而直肠无病变的病例为正常对照组.测量计算T2WI中病灶或正常直肠壁与右侧臀大肌的信号强度比值(SIL/SIM)、表观弥散系数(ADC)值、髂外动脉增强达高峰后第2个序列的病变信号强度净增值与髂外动脉信号强度净增值的比值(SIL/SIA),观察时间-信号强度曲线(TIC)形态,划分良性型(平坦型和持续强化型)与恶性型(迅速强化型).以手术病理结果或临床综合诊断结果为最后诊断.结果 28例患者中共检出不同性质的病灶29个,其中直肠癌复发病灶17个,良性病灶12个,包括纤维瘢痕组织4个(其中陈旧性脓肿1个),慢性炎性病灶6个,瘘管1个,脓肿1个；有14个病灶经手术病理证实.SIL/SIM在良性组为2.84±1.52,恶性组为2.58±0.80,正常对照组为2.13±0.58;3组间比较,差异无统计学意义(F=1.620,P=0.211).以(1.21×10-3) mm2/s为阈值,ADC值诊断恶性病变的敏感性为100％(17/17),特异性为91.7％(11/12),准确性为96.6％(28/29) (Kappa检验P=0.928),诊断一致性好;以0.28为阈值,SIL/SIA诊断的敏感性为100％(13/13),特异性为66.7％(8/12),准确性为84.0％(21/25)(Kappa检验P=0.675),诊断一致性中等；以TIC为诊断标准,诊断的敏感性为100％(13/13),特异性为83.3％(10/12),准确性为92.0％ (23/25).结论 T2WI技术无法鉴别诊断直肠癌术后检出的良、恶性病变;DWI技术和3D-VIBE动态增强技术均具有较高的鉴别诊断效能.
目的 評價3.0 T MR的T2加權成像(T2WI)、瀰散加權成像(DWI)和三維容積內插屏氣檢查(3D-VIBE)在直腸癌術後腫瘤複髮與良性病變鑒彆診斷中的應用價值.方法 迴顧性分析福建醫科大學附屬協和醫院2007年4月至2010年10月經MR檢齣的28例直腸癌術後病變患者的MR影像資料,28例患者均接受T2WI序列和DWI序列檢查,其中有24例接受3D-VIBE序列檢查.選取13例同時期因盆腔其他病變行MR掃描而直腸無病變的病例為正常對照組.測量計算T2WI中病竈或正常直腸壁與右側臀大肌的信號彊度比值(SIL/SIM)、錶觀瀰散繫數(ADC)值、髂外動脈增彊達高峰後第2箇序列的病變信號彊度淨增值與髂外動脈信號彊度淨增值的比值(SIL/SIA),觀察時間-信號彊度麯線(TIC)形態,劃分良性型(平坦型和持續彊化型)與噁性型(迅速彊化型).以手術病理結果或臨床綜閤診斷結果為最後診斷.結果 28例患者中共檢齣不同性質的病竈29箇,其中直腸癌複髮病竈17箇,良性病竈12箇,包括纖維瘢痕組織4箇(其中陳舊性膿腫1箇),慢性炎性病竈6箇,瘺管1箇,膿腫1箇；有14箇病竈經手術病理證實.SIL/SIM在良性組為2.84±1.52,噁性組為2.58±0.80,正常對照組為2.13±0.58;3組間比較,差異無統計學意義(F=1.620,P=0.211).以(1.21×10-3) mm2/s為閾值,ADC值診斷噁性病變的敏感性為100％(17/17),特異性為91.7％(11/12),準確性為96.6％(28/29) (Kappa檢驗P=0.928),診斷一緻性好;以0.28為閾值,SIL/SIA診斷的敏感性為100％(13/13),特異性為66.7％(8/12),準確性為84.0％(21/25)(Kappa檢驗P=0.675),診斷一緻性中等；以TIC為診斷標準,診斷的敏感性為100％(13/13),特異性為83.3％(10/12),準確性為92.0％ (23/25).結論 T2WI技術無法鑒彆診斷直腸癌術後檢齣的良、噁性病變;DWI技術和3D-VIBE動態增彊技術均具有較高的鑒彆診斷效能.
목적 평개3.0 T MR적T2가권성상(T2WI)、미산가권성상(DWI)화삼유용적내삽병기검사(3D-VIBE)재직장암술후종류복발여량성병변감별진단중적응용개치.방법 회고성분석복건의과대학부속협화의원2007년4월지2010년10월경MR검출적28례직장암술후병변환자적MR영상자료,28례환자균접수T2WI서렬화DWI서렬검사,기중유24례접수3D-VIBE서렬검사.선취13례동시기인분강기타병변행MR소묘이직장무병변적병례위정상대조조.측량계산T2WI중병조혹정상직장벽여우측둔대기적신호강도비치(SIL/SIM)、표관미산계수(ADC)치、가외동맥증강체고봉후제2개서렬적병변신호강도정증치여가외동맥신호강도정증치적비치(SIL/SIA),관찰시간-신호강도곡선(TIC)형태,화분량성형(평탄형화지속강화형)여악성형(신속강화형).이수술병리결과혹림상종합진단결과위최후진단.결과 28례환자중공검출불동성질적병조29개,기중직장암복발병조17개,량성병조12개,포괄섬유반흔조직4개(기중진구성농종1개),만성염성병조6개,루관1개,농종1개；유14개병조경수술병리증실.SIL/SIM재량성조위2.84±1.52,악성조위2.58±0.80,정상대조조위2.13±0.58;3조간비교,차이무통계학의의(F=1.620,P=0.211).이(1.21×10-3) mm2/s위역치,ADC치진단악성병변적민감성위100％(17/17),특이성위91.7％(11/12),준학성위96.6％(28/29) (Kappa검험P=0.928),진단일치성호;이0.28위역치,SIL/SIA진단적민감성위100％(13/13),특이성위66.7％(8/12),준학성위84.0％(21/25)(Kappa검험P=0.675),진단일치성중등；이TIC위진단표준,진단적민감성위100％(13/13),특이성위83.3％(10/12),준학성위92.0％ (23/25).결론 T2WI기술무법감별진단직장암술후검출적량、악성병변;DWI기술화3D-VIBE동태증강기술균구유교고적감별진단효능.
Objective To evaluate the value of T2WI,DWI and 3D-VBIE at 3.0 T MR in the differentiation of recurrent rectal cancer and benign pelvic lesions after curative rectal operation.Methods A total of 28 patients with abnormal pelvic lesions confirmed by CT or MR from April 2007 to October 2010 were evaluated with MR imaging.All the patients received examinations of both T2WI and DWI,and 24 of them received additional examination of 3D-VIBE.Thirteen patients with MR imaging in the same period who were confirmed to have no diseases of the rectum were used as control group.The mean apparent diffusion coefficient(ADC) value and the ratio of the signal intensity(SI) of the lesions to the gluteus maximus in T2WI (SIL/SIM) and the ratio of the net added signal intensity of the lesions to the net added signal intensity of the iliac artery (SIL/SIA) at the time of 35 seconds after the iliac artery achieved its highest intensity were measured and calculated.The type of the time-intensity curve(TIC) was overviewed and classified as the benign type when the TIC was rising slowly or constantly and lasted for more than 90 s; however the malignant type when the TIC was rising significantly but lasted less than 90s kept as a horizontal line for a period or was descending slowly or rising slowly.Results There were 29 lesions of different final diagnosis,including 17 recurrence rectal cancers,4 fibrous masses,6 stoma inflammations,1 sinus and 1 abscess.Fourteen of them were confirmed by pathological examination.The ratio of SIL/SIM was 2.84±1.52 in the benign group,2.58±0.80 in the malignant group,and 2.13±0.58 in the control group,the differences between the 3 groups were not statistically significant (F=1.620,P=0.211).When the ADC value of 1.21×10-3 mm2/s was set as a diagnostic threshold,the sensitivity,specificity,accuracy and coherence for the diagnosis of the malignant lesions were 100％(17/17),91.7％(11/12),96.6％(28/29) and 0.928,respectively.When the SIL/SIA value of 0.28 was set as a diagnostic threshold,the sensitivity,specificity,accuracy and coherence for the diagnosis of the malignant lesions were 100％(13/13),66.7％(8/12),84.0％(21/25) and 0.675.When considering the TIC as the diagnostic standard,the sensitivity,specificity and accuracy for the diagnosis of the malignant lesions were 100％ (13/13),83.3％ (10/12) and 92.0％ (23/25),respectively.Conclusion The signal intensity of T2WI has no specificity in the differentiation of malignant lesions and benign lesions while the DWI and the 3D-VIBE have high values in it.
