天津医药

天津医药 ›› 2022, Vol. 50 ›› Issue (2): 200-205.doi: 10.11958/20211221

• 应用研究 • 上一篇    下一篇

IVIM参数兴趣区的选择在评估直肠癌肿瘤血管生成和淋巴血管侵犯中的应用价值

廖宗慧，袁艺，蒲红，李杭
  

  1. 四川省医学科学院•四川省人民医院放射科（邮编610072）

  • 收稿日期:2021-05-24 修回日期:2021-09-08 出版日期:2022-02-15 发布日期:2022-02-15
  • 通讯作者: 李杭 E-mail:lihang111222@126.com
  • 作者简介:省基符，较新；统计见三修附件
  • 基金资助:
    四川省重点研发项目（2019YFS0437）

The application value of region of interest selection for intravoxel incoherent motion diffusion-weighted imaging parameters in the evaluation of tumor angiogenesis and lymphovascular invasion in rectal cancer

LIAO Zonghui , YUAN Yi, PU Hong, LI Hang #br#   

  1. Department of Radiology, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu 610072, China
  • Received:2021-05-24 Revised:2021-09-08 Published:2022-02-15 Online:2022-02-15

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摘要： 目的 探讨体素内不相干运动成像（IVIM）兴趣区（ROI）的选择评估直肠癌微血管密度（MVD）、血管内皮 生长因子（VEGF）表达和淋巴血管侵犯（LVI）的应用价值。方法 54例直肠癌患者术前均行直肠MRI和IVIM序列 检查。采用3种ROI法（容积ROI、最大层面面积ROI、小ROI）分别测量病灶的纯扩散系数（D）、灌注相关假扩散系数 （D*）、灌注分数（f）。采用免疫组化检测 MVD、VEGF、LVI 的表达。通过比较受试者工作特征（ROC）曲线下面积 （AUC），评估各参数对MVD、VEGF、LVI的诊断效能。结果 2位医生采用3种ROI法检测各参数值中，容积ROI测 得D值、D*值、f值的一致性最好，而IVIM的3个参数中D值诊断的一致性普遍更有优势。MVD低、高表达者中仅容 积ROI测量的D值差异有统计学意义（P＜0.05）。VEGF阴、阳性患者中仅容积ROI和小ROI测量的D值差异有统计 学意义（P＜0.05）。LVI阴性和阳性患者中仅容积ROI测量的D值差异有统计学意义（P＜0.05）。ROC曲线分析结果 显示，容积ROI的D值判断MVD、VEGF及LVI效果较好，尤其判断MVD高表达的敏感度有优势；小ROI的D值诊断 VEGF阴性表达的特异度较高。结论 D值可在一定程度上反映直肠癌血管生成情况，尤其是容积ROI法测得的D 值能更客观准确地评估直肠癌术前MVD、VEGF和LVI的状态。

关键词: 直肠肿瘤, 扩散磁共振成像, 微血管, 血管内皮生长因子类, 体素内不相干运动成像, 兴趣区

Abstract: Objective To evaluate the application value of region of interest (ROI) selection for intravoxel incoherent motion (IVIM) diffusion-weighted imaging parameters with MVD, VEGF and LVI in rectal cancer. Methods Fifty-four patients with rectal cancer underwent preoperative IVIM and conventional MRI were included in this study. Three methods of ROI measurements (volume ROI, maximum area ROI and small ROI) were used to independently measure the IVIM parameters including pure diffusion coefficient (D), perfusion-related diffusion coefficient (D*), and perfusion fraction (f) values of the rectal cancer. The expressions of VEGF, MVD and LVI were detected by immunohistochemical staining. IVIM parameters were analyzed in the different expressions of VEGF, MVD and LVI in rectal cancers. The receiver operating characteristic (ROC) curve of each parameter of IVIM was analyzed, and the area under the ROC curve (AUC) was calculated to evaluate the diagnostic performance of each parameter for VEGF, MVD and LVI. Results Among the three ROI methods used by 2 doctors to detect each parameter value, the consistency of D value, D* value and f value measured by volume ROI was the best, and the consistency of D value diagnosis among the three parameters of IVIM was generally more advantageous. Among the low and high MVD expressions, only the D value measured by the volume ROI showed a significant difference (P＜0.05). In VEGF negative and positive patients, only the volume ROI and small ROI measured D values were significant (P＜0.05). In LVI-negative and positive patients, only the D value measured by volume ROI had a statistically significant difference (P＜0.05). ROC curve analysis results showed that the D value of volume ROI was better for judging MVD, VEGF and LVI, especially for judging the sensitivity of high MVD expression. The D value of small ROI showed better specificity for diagnosing negative expression of VEGF. Conclusion D value can reflect the angiogenesis of rectal cancer. In particular, D value measured by volume ROI can more objectively and accurately evaluate the MVD, VEGF and LVI before surgery.

Key words: rectal neoplasms, diffusion magnetic resonance imaging, microvessels, vascular endothelial growth factors,  intravoxel incoherent motion, region of interest