作者：文自强1，杨心悦1，陈琰1，卢宝兰1，肖晓娟2，庄晓曌3，余深平1

单位：1.中山大学附属第一医院 放射科，广东 广州 510080； 2.北京大学深圳医院 放射科，广东 深圳 518036； 3.海南省人民医院 放射科，海南 海口 570311

Authors:  WEN Ziqiang1，YANG Xinyue1，CHEN Yan1，LU Baolan1，XIAO Xiaojuan2，ZHUANG Xiaozhao2，YU Shenping1

Unit:  1.Department of Radiology，The First Affiliated Hospital，Sun Yat-Sen University，Guangzhou 510080，Guangdong, China; 2. Department of Radiology，Shenzhen Hospital，Peking University，Shenzhen 518036，Guangdong, China; 3. Department of Radiology，Hainan Provincial People's Hospital，Haikou 570311，Hainan, China

摘要：

目的  采用扩散峰度成像(diffusion kurtosis imaging, DKI)各参数定量评价直肠癌不同组织学类型及病理分级,以探究DKI在鉴别直肠癌不同亚型及病理分级的临床诊断价值。方法  对116例确诊直肠普通腺癌和16例确诊直肠黏液腺癌患者行术前直肠癌常规高分辨磁共振成像及DKI;勾画感兴趣区域(region of interest, ROI),使用DKI参数图测量肿瘤实质区和正常肠壁的DKI参数(D,K值);比较直肠普通腺癌的肿瘤实质与正常肠壁各参数,再比较直肠普通腺癌与黏液腺癌,以及普通腺癌不同分化程度的DKI参数。参数比较采用Wilcoxon和Mann-Whitney U检验。结果  直肠普通腺癌肿瘤实质的K值明显高于正常肠壁(0.94±0.09 vs.0.59±0.12,P<0.001),而D值明显低于正常肠壁(1.28±0.15vs.2.20±0.34,P<0.001)。此外,直肠普通腺癌K值显著高于黏液腺癌(0.94±0.09 vs.0.68±0.09,P<0.001),D值显著低于黏液腺癌(1.28±0.15 vs.1.89±0.25,P<0.001)。而在普通腺癌不同分化程度的比较中,高中分化与低分化的DKI各参数差异均无统计学意义。结论  DKI可用于直肠癌不同组织类型的鉴别,但其在腺癌病理分级的诊断价值有待进一步研究确定。

关键词： 直肠癌; 扩散峰度成像; 黏液腺癌; 病理分级

Abstract：

Objective  To explore the clinical diagnostic value of parameters of diffusion kurtosis imaging (DKI) for distinguishing different subtypes and pathological grading of rectal adenocarcinoma. Methods  Between January 2015 and December 2016, 116 patients (median age, 59.5 years; age range, 29-83 years) with pathologically confirmed diagnosis of unspecified rectal adenocarcinoma and 16 patients with mucinous rectal carcinoma were prospectively included. All patients underwent routine MR examination and DKI sequence. Parameters of DKI, including diffusivity and kurtosis values, were collected by drawing regions of interest (ROIs) on tumor parenchyma and normal rectal wall. Those parameters were compared between different subtypes of adenocarcinoma or various grades in unspecified carcinoma. Wilcoxon test and Mann-Whitney U test were used for statistics analysis. Result  Kurtosis value was significantly higher in unspecified rectal carcinoma than that in normal rectal wall (0.94±0.09 vs. 0.59±0.12, P<0.001) and mucinous rectal carcinoma (0.94±0.09 vs. 0.68±0.09, P<0.001). Diffusivity value was significantly lower in unspecified rectal carcinoma than in normal rectal wall (1.28±0.15 vs. 2.20±0.34, P<0.001) and mucinous rectal carcinoma (1.28±0.15 vs. 1.89±0.25, P<0.001). There were no significant differences in parameters of DKI between different pathological grading. Conclusion  DKI parameters could be used in discriminating different histologic types of rectal adenocarcinoma, but its value in evaluating different pathological grades need to confirm with more studies.

Key Words:  Rectal cancer; Diffusion Kurtosis Imaging; Mucinous carcinoma; Pathological grade