Clinical value of dynamic enhanced MR Combined with high resolution MR for lymph node metastasis of rectal adenocarcinoma
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摘要:
目的 探讨动态增强MR联合高分辨率MR对直肠腺癌淋巴结转移的临床价值。 方法 纳入上海交通大学附属第一人民医院2018年1月~2022年12月收治的196例经病理证实为直肠癌患者的临床资料，所有患者均在该院完成高分辨率MRI和动态增强扫描MRI检查。根据术后病理将患者分为无淋巴结转移组（n=124）和淋巴结转移组（n=72），分析两组间临床特征、动态增强MR定量参数和高分辨率MR影像表现的差异，采用Logistic回归分析筛选预测直肠癌淋巴结转移的因素，采用ROC曲线计算不同参数预测淋巴结转移的效能。 结果 单因素Logistic回归分析显示，直肠腺癌淋巴结转移的危险因素是年龄 < 59.5岁（OR：0.329）、N分期MR影像学表现（mrN stage）为N1-N2期（OR：6.857）、癌胚抗原异常（OR：2.742）、T分期MR影像学表现（mrT stage）为T3期（OR：2.959）、mrMRF受累阳性（OR：5.577）、动态增强扫描MRI定量参数Ktrans < 0.298 min-1（OR：0.210）及mr EMVI阳性（OR：2.261）。多因素Logistic回归分析显示mrN stage阳性和Ktrans是直肠腺癌淋巴结转移的独立预测因素；mrN stage+Ktrans预测直肠腺癌淋巴结转移的AUC（0.788）高于单独的mrN stage（0.713）及Ktrans（0.650）。 结论 动态增强MR定量参数Ktrans联合mrN stage能够提高直肠腺癌淋巴结转移患者的预测能力。 -
关键词:
- 动态对比增强磁共振成像 /
- 高分辨率磁共振成像 /
- 直肠腺癌 /
- 淋巴结转移
Abstract:Objective To investigate the clinical value of dynamic contrast-enhanced MR combined with high resolution MR in lymph node metastasis of rectal adenocarcinoma. Methods Clinical data of 262 patients with pathologically confirmed rectal cancer admitted to the First People's Hospital Affiliated to Shanghai Jiao Tong University from January 2018 to December 2022 were collected. All patients underwent high resolution MR and contrast-enhanced MR in the hospital. According to postoperative pathology, the patients were divided into two groups: no lymph node metastasis group (n=124) and lymph node metastasis group (n=72). The differences in clinical features, quantitative parameters of dynamic contrast-enhanced MR and high resolution MR between the two groups were analyzed, and the factors predicting lymph node metastasis of rectal cancer were screened by Logistic regression analysis. ROC curve was used to calculate the efficacy of different parameters in predicting lymph node metastasis. Results Univariate Logistic regression analysis showed that the risk factors for lymph node metastasis of rectal adenocarcinoma were age < 59.5 years old (OR: 0.329), mrN stage N1-N2 (OR: 6.857)、abnormal carcinoembryonic antigen (OR: 2.742), mrT stage T3 (OR: 2.959), mrMRF positive (OR: 5.577), Quantitative parameter Ktrans of dynamic contrast-enhanced MR < 0.298 min-1 (OR: 0.210) and mr EMVI positive (OR: 2.261). Multivariate Logistic regression analysis showed that mrN stage positive and Ktrans were independent predictors of lymph node metastasis in colorectal adenocarcinoma. The AUC of mrN stage + Ktrans (0.788) in predicting lymph node metastasis of rectal adenocarcinoma was higher than single mrN stage (0.713) and Ktrans (0.650). Conclusion Quantitative parameter Ktrans of dynamic contrast-enhanced MR combined with mrN stage can improve the prediction ability of patients with rectal adenocarcinoma lymph node metastasis. -
图 1 HR-MRI淋巴结形态学特征
Figure 1. Morphological characteristics of lymph nodes on HR-MRI. A: Round (ratio of length to diameter less than 1.5 times); B: Irregular border; C: The signal was uneven.
图 2 Ktrans、mrN stage及联合预测直肠癌淋巴结转移的ROC曲线
Figure 2. ROC curve of Ktrans, mrN stage and combined prediction of lymph node metastasis of rectal cancer.
表 1 两组一般资料
Table 1. General data between the two groups (n)
Index With LNM（n=72） Without LNM（n=124） t/χ2 P Gender（Male/Female, n） 49/23 72/52 1.925 0.165 Age (years, Mean±SD) 62.4±8.9 66.4±7.6 2.451 0.037 CEA (n) 5.903 0.015 ＜5 ng/mL 42 93 ≥5 ng/mL 30 31 CA19-9 (n) 1.926 0.165 ＜39 U/mL 64 117 ≥39 U/mL 8 7 Tumor length（cm, Mean±SD） 4.3±1.3 3.8±1.3 -1.920 0.057 Tumor location (n) 2.450 0.294 Upper 20 40 Middle 36 48 Lower 16 36 mrT stage (n) 12.645 ＜0.001 T1-T2 24 74 T3 48 50 mrN stage (n) 35.153 ＜0.001 N0 25 96 N1-N2 47 28 mrMRF (n) 7.867 0.005 Negative 51 108 Positive 21 16 mrEMVI (n) 4.934 0.026 Negative 50 103 Positive 22 21 CEA: Carcinoembryonic antigen; CA19-9: Glycoprotein antigen 19-9; mrT stage: HR-MRI reported tumor stage; mrN stage: HRMRI reported lymp node stage; mrMRF: HR-MRI reported mesorectal fasciae status; mrEMVI: HR-MRI reported extramural vascular invasion status; LNM: Lymph node metastasis. 
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表 2 两组DCE-MRI定量参数的比较
Table 2. Comparison of DCE-MRI quantitative parameters between the two groups
Variable With LNM（n=72） Without LNM（n=124） t P Kep [min-1, M(P25, P75)] 1.139(0.798, 2.372) 1.415(0.943, 2.449) 0.896 0.462 Ktrans [min-1, M(P25, P75)] 0.247(0.190, 0.330) 0.362(0.245, 0.502) 2.461 0.015 Ve (Mean±SD) 0.289±0.109 0.321±0.111 1.366 0.172 iAUC (Mean±SD) 13.966±8.526 16.565±9.529 0.885 0.377 Kep: Rate constant from extravascular-extracellular space to blood plasma (min-1); Ktrans: Volume transfer constant between extravascular-extracellular space and blood plasma (min-1); Ve: Extravascular-extracellular space volume per unit tissue volume; iAUC: Initial area under the curve.
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表 3 不同参数预测直肠癌淋巴结转移的能力
Table 3. Ability of different parameters to predict lymph node metastasis of rectal cancer
Variable AUC Cutoff value Specificity（%） Sensitivity（%） Negative predictive value（%） Positive predictive value（%） P Age 0.626 < 59.5 years old 88.7 27.8 67.9 58.5 0.039 CEA 0.623 abnormal 77.4 47.2 71.6 54.8 0.043 mrN stage 0.713 N1-N2 77.4 66.7 80.0 63.2 < 0.001 mrT stage 0.632 T3 61.4 66.7 75.5 49.0 0.03 Ktrans 0.650 < 0.298 min-1 67.7 69.4 79.2 55.6 0.015 mr EMVI 0.592 Positive 82.3 36.1 68.9 54.2 0.131 mrMRF 0.607 Positive 93.5 27.8 69.0 71.4 0.079 CEA: Carcinoembryonic antigen.
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表 4 预测直肠癌淋巴结转移的Logistic回归分析
Table 4. Logistic regression analysis for predicting lymph node metastasis of rectal cancer
Variable Univariate Logistic regression analysis Multivariate Logistic regression analysis OR（95% CI） P OR（95% CI） P Age 0.329（0.112，0.967） 0.043 CEA 2.742（1.129，6.658） 0.025 mrN stage 6.857（2.749，17.096） < 0.001 5.573（2.150，14.462） < 0.001 mrT stage 2.959（1.254，6.987） 0.013 Ktrans(min-1) 0.210（0.086，0.509） 0.001 0.273（0.105，0.709） 0.008 mr EMVI 2.261（1.022，6.721） 0.045 mrMRF 5.577（1.600，19.434） 0.007
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表 5 Ktrans、mrN stage和联合预测直肠癌淋巴结转移效能的比较
Table 5. Comparison of Ktrans, mrN stage and combined prediction of lymph node metastasis in rectal cancer
Variable AUC 95% CI Specificity（%） Sensitivity（%） mrN stage 0.713 0.613-0.829 77.4 66.7 Ktrans 0.650 0.529-0.767 67.7 69.4 Ktrans+mrN stage 0.788 0.694-0.882 56.5 88.9
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