作者：骆允1，孟祥安1，郝永欣1，董亚青1，许雅芳2

单位：1.河北中石油中心医院 超声医学科，河北 廊坊 065000;  2.河北中石油中心医院 医学影像科，河北 廊坊 065000

Authors: Luo Yun1, Meng Xiang'an1, Hao Yongxin1, Dong Yaqing1, Xu Yafang2

Unit:  1.Ultrasonography Department，Hebei Petro China Central Hospital, Langfang 065000, Hebei, China;  2.Medical Imaging Department，Hebei Petro China Central Hospital, Langfang 065000, Hebei, China

摘要：

目的  探讨经直肠超声（transrectal ultrasound, ERUS）、剪切波弹性成像（shear wave elastography, SWE）和多层螺旋计算机体层摄影（multi-slice spiral computed tomography, MSCT）的多模态影像组学分析对直肠癌淋巴结转移的预测价值。方法  选取2021年1 月至2022年5月在河北中石油中心医院治疗的直肠癌患者100例，其中伴有淋巴结转移患者47例（转移组），不伴有淋巴结转移患者53例（非转移组），比较两组ERUS、SWE 和MSCT 检查参数差异，构建多因素Logistic 回归模型预测直肠癌淋巴结转移。结果  转移组淋巴结长径、淋巴结短径、长短径比值、直肠肿物占肠腔环周＞1/2 比例、直肠肿物超声T3及以上分期比例分别为（7.10±2.01）mm、（6.22±1.02）mm、（1.16±0.24）、76.60%和82.98%，高于非转移组（P＜0.05）。转移组淋巴结最大杨氏模量和淋巴结弹性方差分别为（77.50±24.43）kPa 和（11.50±2.92），高于非转移组（P＜0.05）；转移组和非转移组中位弹性对比度、肿物最大杨氏模量比较差异无统计学意义（P＞0.05）。转移组MSCT 纹理影像参数峰度、熵值分别为（2.51±0.89）和（7.40±0.80），高于非转移组（P＜0.05）。ERUS、SWE 和MSCT 参数构建多因素Logistic回归模型，该模型预测直肠癌淋巴结转移的受试者操作特征曲线的曲线下面积为0.803 （95%CI：0.718~0.888，P＜0.05），敏感度和特异度分别为70.20%和81.10%。结论  ERUS、SWE 和MSCT参数构建的Logistic回归模型在预测直肠癌淋巴结转移方面有较高的价值。

关键词： 经直肠超声；剪切波弹性成像；多层螺旋计算机体层摄影；直肠癌淋巴结转移；预测价值

Abstract：

Objective  To investigate the predictive value of multimodal imaging histology analysis of transrectal ultrasound (ERUS), shear wave elastography (SWE) and multi-slice spiral computed tomography (MSCT) in lymph node metastasis of rectal cancer. Method  100 rectal cancer patients treated in Hebei Petro China Central Hospital from January 2021 to May 2022 were selected, including 47 patients with lymph node metastasis (metastatic group) and 53 patients without lymph node metastasis (non metastatic group), the difference of ERUS, SWE and MSCT examination parameters between the two groups were compared, and a multivariate Logistic regression model to predict lymph node metastasis of rectal cancer was built. Result  The long diameter of lymph node, the short diameter of lymph node, the ratio of long diameter to short diameter, the proportion of rectal tumor occupying more than 1/2 of the circumference of intestinal cavity, and the proportion of ultrasonic T3 stage and above of rectal tumor in the metastatic group were (7.10 ±2.01) mm, (6.22 ±1.02) mm, (1.16 ±0.24), 76.60% and 82.98%, respectively, which were higher than those in the non metastatic group (P<0.05). The maximum Young's modulus and elastic variance of lymph nodes in metastatic group were (77.50 ±24.43) kPa and (11.50 ±2.92), respectively, which were higher than those in non metastatic group (P<0.05). There was no statistically difference in the median elastic contrast and the maximum Young's modulus between the metastatic group and the non metastatic group (P>0.05). The kurtosis and entropy of MSCT texture image parameters in the metastatic group were (2.51±0.89) and (7.40±0.80) respectively, which were higher than those in the non metastatic group (P<0.05). ERUS, SWE and MSCT parameters were used to construct a multivariate Logistic regression model, the area under the receiver operating characteristic curve for predicting lymph node metastasis of rectal cancer was 0.803 (95% CI:0.718 -0.888, P<0.05), and the sensitivity and specificity were 70.20% and 81.10%, respectively. Conclusion  Logistic regression model constructed by ERUS, SWE and MSCT parameters has high value in predicting lymph node metastasis of rectal cancer.

Key Words:  Transrectal ultrasound; Shear wave elastic imaging; Multi-slice spiral computed tomography; Lymph node metastasis of rectal cancer; Forecast value