目的:探讨弥散加权成像(DWI),体素内不相干运动(IVIM),和扩散峰度成像(DKI)评估直肠癌患者的病理预后因素。
方法:这项前瞻性研究共纳入了162例计划接受根治性手术的患者(男性105例,平均年龄61.8±13.1岁)。病理预后因素包括组织学分化,淋巴结转移(LNM),和壁外血管侵犯(EMVI)。DWI,IVIM,使用单变量和多变量逻辑回归获得DKI参数并与预后因素相关。使用受试者工作特征(ROC)曲线分析评估其评估值。
结果:多变量逻辑回归分析显示,较高的平均峰度(MK)(比值比(OR)=194.931,p<0.001)和较低的表观扩散系数(ADC)(OR=0.077,p=0.025)与分化较差的肿瘤独立相关。较高的灌注分数(f)(OR=575.707,p=0.023)和较高的MK(OR=173.559,p<0.001)与LNMs独立相关,较高的f(OR=1036.116,p=0.024),较高的MK(OR=253.629,p<0.001),较低的平均扩散率(MD)(OR=0.125,p=0.038),和较低的ADC(OR=0.094,p=0.022)与EMVI独立相关。MK对组织学分化的ROC曲线下面积(AUC)显著高于ADC(0.771vs.0.638,p=0.035)。LNM阳性的MK的AUC高于f(0.770vs.0.656,p=0.048)。在f(0.663)中,MK与MD的联合AUC(0.790)最高,MK(0.779),MD(0.617),和ADC(0.610)评估EMVI。
结论:DKI参数可作为评估直肠癌术前病理预后因素的影像学生物标志物。
结论:扩散峰度成像(DKI)参数,特别是平均峰度(MK),是评估组织学分化的有前途的生物标志物,淋巴结转移,和直肠癌的壁外血管侵犯。这些发现表明DKI在直肠癌术前评估中的潜力。
结论:在评估可切除直肠癌的组织学分化中,平均峰度优于表观扩散系数。灌注分数和平均峰度是评估直肠癌淋巴结转移的独立指标。平均峰度和平均扩散系数在评估壁外血管侵犯方面具有出色的准确性。
OBJECTIVE: To explore diffusion-weighted imaging (DWI), intravoxel incoherent motion (IVIM), and diffusion kurtosis imaging (DKI) for assessing pathological prognostic factors in patients with rectal cancer.
METHODS: A total of 162 patients (105 males; mean age of 61.8 ± 13.1 years old) scheduled to undergo radical surgery were enrolled in this prospective study. The pathological prognostic factors included histological differentiation, lymph node metastasis (LNM), and extramural vascular invasion (EMVI). The DWI, IVIM, and DKI parameters were obtained and correlated with prognostic factors using univariable and multivariable logistic regression. Their assessment value was evaluated using receiver operating characteristic (ROC) curve analysis.
RESULTS: Multivariable logistic regression analyses showed that higher mean kurtosis (MK) (odds ratio (OR) = 194.931, p < 0.001) and lower apparent diffusion coefficient (ADC) (OR = 0.077, p = 0.025) were independently associated with poorer differentiation tumors. Higher perfusion fraction (f) (OR = 575.707, p = 0.023) and higher MK (OR = 173.559, p < 0.001) were independently associated with LNMs. Higher f (OR = 1036.116, p = 0.024), higher MK (OR = 253.629, p < 0.001), lower mean diffusivity (MD) (OR = 0.125, p = 0.038), and lower ADC (OR = 0.094, p = 0.022) were independently associated with EMVI. The area under the ROC curve (AUC) of MK for histological differentiation was significantly higher than ADC (0.771 vs. 0.638, p = 0.035). The AUC of MK for LNM positivity was higher than f (0.770 vs. 0.656, p = 0.048). The AUC of MK combined with MD (0.790) was the highest among f (0.663), MK (0.779), MD (0.617), and ADC (0.610) in assessing EMVI.
CONCLUSIONS: The DKI parameters may be used as imaging biomarkers to assess pathological prognostic factors of rectal cancer before surgery.
CONCLUSIONS: Diffusion kurtosis imaging (DKI) parameters, particularly mean kurtosis (MK), are promising biomarkers for assessing histological differentiation, lymph node metastasis, and extramural vascular invasion of rectal cancer. These findings suggest DKI\'s potential in the preoperative assessment of rectal cancer.
CONCLUSIONS: Mean kurtosis outperformed the apparent diffusion coefficient in assessing histological differentiation in resectable rectal cancer. Perfusion fraction and mean kurtosis are independent indicators for assessing lymph node metastasis in rectal cancer. Mean kurtosis and mean diffusivity demonstrated superior accuracy in assessing extramural vascular invasion.