摘要
目的探讨基于多参数MRI的列线图预测克罗恩病(CD)肠壁纤维化的诊断效能。方法前瞻性收集2015年6月至2018年3月中山大学附属第一医院手术病理确诊的CD患者的临床和影像资料。所有患者均于术前2周内行常规MRI及扩散峰度成像(DKI)检查。将在2015年6月至2017年9月期间接受手术的患者纳入模型构建组,在2017年10月至2018年3月期间接受手术的患者纳入模型验证组。分别在扩散加权成像单指数模型和非高斯DKI模型后处理图上测量病变肠壁的表观扩散系数(ADC)、表观扩散峰度(Kapp)值和非高斯分布的表观扩散系数(Dapp)值;并观察其T2WI信号强度和强化方式。每例患者取1~3个标本行马松染色进行肠壁纤维化评分。采用Spearman秩检验评估MRI主客观评价指标与病理评分之间的相关性,使用多因素logistic回归筛选预测肠壁纤维化的独立因素,构建可视化列线图预测模型并验证其诊断效能。结果共入组40例患者,模型构建组31例,模型验证组9例。模型构建组中31例患者共取得81个标本,根据纤维化分级将其分为无-轻度纤维化组(n=32)和中-重度纤维化组(n=49)。模型构建组中,中-重度纤维化组Kapp值高于无-轻度纤维化组,Dapp值、ADC值低于无-轻度纤维化组,差异均有统计学意义(Z=-5.999、-4.521、-3.893,P均<0.001),T2WI信号强度、强化方式差异均无统计学意义(χ^2=1.571、0.103,P均>0.05)。病变肠壁的Kapp值、Dapp值与纤维化病理评分分别呈中等、轻度相关性(r=0.721、-0.483,P均<0.001),ADC值与纤维化评分呈轻度相关性(r=-0.445,P<0.001)。多因素logistic回归分析显示Kapp和Dapp值为预测肠壁纤维化的独立因素。列线图预测模型鉴别无-轻度和中-重度纤维化的效能较好,其内部和外部验证的Harrell一致性指数分别为0.901(95%可信区间0.824~0.978)和1.000。结论基于DKI的列线图可评估CD患者肠壁纤维化,并为临床提供一种可视化�
Objective To explore the diagnostic efficacy of nomogram based on multi-parameter MRI for assessment of bowel fibrosis in patients with Crohn disease(CD).Methods The clinical and imaging data of CD patients diagnosed by surgical histopathology in the First Affiliated Hospital of Sun Yat-sen University from June 2015 to March 2018 were prospectively collected.All the patients underwent conventional MRI and diffusion kurtosis imaging(DKI)within 2 weeks before surgery.Patients who underwent surgery between June 2015 and September 2017 were included in the model building group,and those who underwent surgery between October 2017 and March 2018 were included in the model validation group.We measured the apparent diffusion coefficient(ADC)from monoexponential model of diffusion-weighted imaging(DWI),apparent diffusional kurtosis(Kapp),and apparent diffusion for non-Gaussian distribution(Dapp)from non-Gaussian DKI model,and observed T2WI signal intensity and enhancement pattern of the same segment.One to three intestinal specimens per patient were stained with Masson′s trichrome for the histological grading of fibrosis.Correlations between qualitative/quantitative MRI indexes and histological grades were evaluated using the Spearman rank test.Multivariate logistic regression analysis was performed to identify independent factors to be included into the nomogram for predicting the degree of bowel fibrosis and its diagnostic performance was assessed by internal and external validation.Results A total of 40 CD patients were included,including 31 in the model construction group and 9 in the model verification group.A total of 81 intestinal specimens from 31 patients were graded as none-to-mild bowel fibrosis(n=32)and moderate-to-severe bowel fibrosis(n=49)according to a scoring system of fibrosis.In the training cohort,the Kapp value of moderate-to-severely fibrotic bowel walls was significantly higher than that of none-to-mildly fibrotic bowel walls,and the Dapp and ADC values of moderate-to-severely fibrotic bowel walls
作者
杜金芳
黄丽
毛弈涛
黄斯韵
卢宝兰
钟英奎
孟霁昕
孙灿辉
冯仕庭
李雪华
Du Jinfang;Huang Li;Mao Yitao;Huang Siyun;Lu Baolan;Zhong Yingkui;Meng Jixin;Sun Canhui;Feng Shiting;Li Xuehua(Department of Radiology,The First Affiliated Hospital,Sun Yat-sen University,Guangzhou 510080,China;Department of Radiology,Xiangya Hospital,Central South University,Changsha 410008,China)
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2020年第8期792-798,共7页
Chinese Journal of Radiology
基金
国家自然科学基金(81600508,81770654,81870451,81771908)。
