發(fā)布時(shí)間：2018-08-23 11:45

【摘要】：目的：探討磁共振彌散峰度成像(Diffusional Kurtosis Imaging DKI)在直腸癌診斷中的價(jià)值 材料與方法：對(duì)2013年7月至2014年2月就診我院128例直腸疾病患者行常規(guī)MRI掃描及DKI掃描，檢查后28例患者2周內(nèi)直接行手術(shù)治療。掃描采用5個(gè)B值（0,500,1000,1500,2000sec/mm2），3個(gè)擴(kuò)散梯度場(chǎng)。圖像通過(guò)Permeability軟件處理后獲得病變及正常腸壁DKI參數(shù)：平均表觀彌散系數(shù)MD以及平均峰度系數(shù)MK。所有數(shù)據(jù)應(yīng)用SPSS19.0統(tǒng)計(jì)軟件進(jìn)行分析。 結(jié)果：28例患者中，中分化腺癌20例、低分化腺癌1例、粘液腺癌3例、腺瘤1例、炎癥3例。直腸癌MD及MK平均值分別為1.30±0.27×10-3mm2/sec,1.07±0.16，炎癥的參數(shù)值分別為1.63±0.07×10-3mm2/sec，0.84±0.05，而正常腸壁的參數(shù)值分別為1.81±0.35×10-3mm2/sec,0.83±0.21。腫瘤和正常腸壁，腫瘤與炎癥，中分化腺癌與粘液腺癌間MD值與MK值差異有統(tǒng)計(jì)學(xué)意義（p0.05）。診斷直腸癌MD值及MK值的受試者ROC曲線下的面積均較高，分別為0.907及0.849。以MD值≤1.446×10-3mm2/sec作為診斷直腸癌的閾值時(shí)，其診斷的敏感性為92%,特異性為79%；以MK值≥0.908作為診斷直腸癌的閾值時(shí)，敏感性為83%，特異性68%。診斷中分化腺癌MD值與MK值ROC曲線下面積分別為0.857及0.889；以MD值≤1.263×10-3mm2/sec作為診斷中分化腺癌閾值時(shí)，敏感性為100%，特異性為57%，MK值≥0.958作為診斷中分化腺癌閾值時(shí)，，敏感性為86%，特異性為67%。DK參數(shù)在正常腸壁及炎癥間、有無(wú)淋巴結(jié)轉(zhuǎn)移直腸癌患者間、各不同術(shù)后TNM及Dukes分期間無(wú)顯著統(tǒng)計(jì)學(xué)差異（p0.05）。直腸癌DK-MRI參數(shù)與術(shù)后標(biāo)本T分期、N分期、病理分期、DUKES分期間無(wú)顯著相關(guān)。結(jié)論：初步研究發(fā)現(xiàn)DKI參數(shù)具有鑒別正常腸壁、炎癥與腺癌的潛力，能夠反映直腸癌微觀結(jié)構(gòu)的復(fù)雜性。
[Abstract]:Objective: to evaluate the value of (Diffusional Kurtosis Imaging DKI) in the diagnosis of rectal cancer: from July 2013 to February 2014, 128 patients with rectal diseases in our hospital underwent routine MRI and DKI scans. After examination, 28 patients underwent direct surgical treatment within 2 weeks. The scan was performed with 5 B values (0 / 500 / 1000 / 1500 / 2000 sec-mm2) and 3 diffusion gradient fields. The DKI parameters of lesion and normal intestinal wall were obtained by Permeability software. The mean apparent diffusion coefficient (MD) and the mean kurtosis coefficient (MK) were obtained. All data were analyzed by SPSS19.0 statistical software. Results among 28 patients, 20 cases were moderately differentiated adenocarcinoma, 1 case was poorly differentiated adenocarcinoma, 3 cases were mucinous adenocarcinoma, 1 case was adenoma and 3 cases were inflammation. The mean values of MD and MK in rectal cancer were 1.30 鹵0.27 脳 10 ~ (-3) mm ~ (-2) / secg ~ (2) and 1.07 鹵0.16, respectively. The parameters of inflammation were 1.63 鹵0.07 脳 10 ~ (-3) mm ~ (-2) / sec0.84 鹵0.05 respectively, while those of normal intestinal wall were 1.81 鹵0.35 脳 10 ~ (-3) mm ~ (-2) / sec0.83 鹵0.21 respectively. There were significant differences in MD and MK between tumor and normal intestinal wall, tumor and inflammation, middle differentiated adenocarcinoma and mucinous adenocarcinoma (p0.05). The area under the ROC curve of the subjects diagnosed with MD and MK were 0.907 and 0.849, respectively. When the threshold value of MD 鈮

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