Value of MRI diffusion weighted imaging parameter ADC value in evaluating the differentiation degree and tumor microstructure of rectal cancer
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摘要:
目的 探讨磁共振弥散加权成像参数表观扩散系数（ADC）值术前评估直肠癌分化程度及瘤体微观结构的价值。 方法 收集2018~2021年经病理证实的直肠癌患者82例，所有患者在接受3.0 T弥散加权成像检查后均测量瘤体ADC值，分析不同分化程度直肠癌ADC值的差异，通过ROC曲线确定ADC值区分直肠癌分化程度的效能，并研究ADC值与微血管密度、血管内皮生长因子和微淋巴管密度的相关性。 结果 高、中分化直肠癌ADC值[(1.16±0.05)×10-3 mm2/s、(1.04±0.08)×10-3 mm2/s]高于低分化直肠癌[(0.93±0.07)×10-3 mm2/s]，差异有统计学意义（P < 0.05）；ROC曲线显示，ADC值区分低分化与高、中分化直肠癌的最佳临界值为1.05×10-3 mm2/s，曲线下面积为0.902 (95% CI: 0.831~0.972)；直肠癌瘤体ADC值与微血管密度、血管内皮生长因子阳性细胞百分比及微淋巴管密度均呈负相关关系（r=-0.56、-0.61、-0.59，P < 0.05）。 结论 直肠癌瘤体ADC值有助于术前评估肿瘤分化程度和微观结构特点，间接反映肿瘤血管新生和微淋巴管密度。 Abstract:Objective To investigate the diagnostic value of the apparent diffusion coefficient (ADC) of MRI diffusion weighted imaging parameters in preoperative assessment of the differentiation degree and tumor microstructure of rectal cancer. Methods A total of 82 patients with rectal cancer confirmed pathologically from 2018 to 2021 were collected. The ADC values of tumors were measured in all patients after 3.0 T diffusion weighted imaging, and the difference in ADC values of rectal cancers with different levels of differentiation was analyzed. ROC curve was used to determine the efficacy of ADC value in differentiating the differentiation degree of rectal cancer. The correlation between ADC value and microvessel density, vascular endothelial growth factor and microvessel density was analyzed. Results The ADC value of high [(1.16±0.05)×10-3 mm2/s] and moderately [(1.04±0.08)×10-3 mm2/s] differentiated rectal cancer was significantly higher than that of poorly differentiated rectal cancer [(0.93±0.07)×10-3 mm2/s, P < 0.05]. ROC curve showed that the optimal critical value of ADC value to distinguish poorly differentiated from well-differentiated and moderately differentiated rectal cancer was 1.05×10-3 mm2/s, and the AUC was 0.902 (95%CI: 0.831-0.972). The ADC value and microvessel density, the percentage of vascular endothelial growth factor positive cells and microlymphatic vessel density of rectal cancer tumors were all negatively correlated (r=- 0.56, -0.61, - 0.59, P < 0.05). Conclusion The ADC value of rectal cancer tumor is helpful to evaluate tumor differentiation and microstructure characteristics. It indirectly reflects tumor angiogenesis and microlymphatic vessel density. -
图 1 患者男，43岁，低分化直肠癌
A: 横轴位T2WI显示直肠壁肿块呈稍高信号; B: 矢状位T2WI显示肿块位于低位直肠壁; C~D: 横轴位DWI及ADC分别显示直肠壁肿块呈高信号和低信号; E~G: CD34、VEGF和MLVD抗体图像，呈明显阳性表达（SP, ×400）.
Figure 1. A 43-year-old male patient with poorly differentiated rectal cancer.
图 2 患者女，50岁，高分化直肠癌
A: 横轴位T2WI显示直肠壁肿块呈稍高信号；B: 矢状位T2WI显示肿块位于低位直肠壁; C~D: 横轴位DWI及ADC分别显示直肠壁肿块呈高信号和低信号; E~G: CD34、VEGF和MLVD抗体图像，呈明显阳性表达（SP, ×400）.
Figure 2. A50-year-old female patient with well-differentiated rectal cancer.
图 3 不同分化程度直肠癌瘤体ADC值比较结果（A）及ROC曲线评价ADC值区分低分化与高、中分化直肠癌的价值（B）
Figure 3. Comparison of ADC values of rectal cancer with different differentiation degrees (A) and The value of ROC curve to evaluate ADC value in differentiating poorly differentiated from well and moderately differentiated rectal cancer (B)
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