摘要
目的探讨影响盆腔MRI显示腹膜返折(PR)清晰度的因素,分析PR在直肠癌影像诊断中的应用价值。方法回顾性分析2019年1月至2019年6月在我院术前行盆腔MRI检查的55例直肠癌患者的影像和临床资料。取矢状位T2WI为分析对象,分析PR清晰度与临床特征的关系,使用单因素及多因素逻辑回归评价相关因素(性别、年龄、BMI、T分期、AV—PR距离、精囊腺/子宫—肠管距离、膀胱充盈程度、有无盆腔积液、子宫位置)与PR清晰度的关系并建立预测模型列线图(Nomogram)。采用组间相关系数(ICC)、变异系数(CV)及Bland-Altman散点图评估MRI测量AV—PR距离的一致性。以术中所见为基准,采用Kappa检验评估MRI判断肿瘤与PR相对位置的准确性。结果BMI、精囊腺/子宫—肠管距离与PR清晰度有关(均P<0.05)。单因素及多因素Logistic回归分析结果显示BMI、精囊腺/子宫—肠管距离与PR清晰度有关(均P<0.05),Nomogram判断准确度为78.2%。AV—PR距离测量的ICC值为0.822,CV值为4.74%,Bland-Altman分析显示Bias(LoA)为-0.024(-1.326~1.279)。MRI与术后病理判断肿瘤与PR相对位置的一致性较好(Kappa值为0.759)。结论BMI、精囊腺/子宫—肠管距离为矢状位T2WI显示PR清晰度的影响因素,在矢状位T2WI测量AV—PR距离、判断直肠癌与PR相对位置均有较高的临床指导价值。
Objectives To investigate the factors influencing the visibility of peritoneal reflection(PR)on magnetic resonance imaging(MRI)and the value of PR recognition in diagnostic imaging of rectal cancer.Methods This was a retrospective analysis of images and clinical data from 55 patients who underwent preoperative pelvic MRI between January 2019 and June 2019.The sagittal T2-weighted images(T2WI)were analyzed to assess PR’s visibility and its relationship with clinical characteristics.Uni-and multivariate logistic regression analyses were performed to investigate the potential factors influencing PR’s visibility.These potential factors included sex,age,body mass index(BMI),T stage,anal verge to the peritoneal reflection(AV-PR)distance,the distance between seminal vesicle/uterus and rectum,bladder fullness,the presence of pelvic fluid,and uterus position.Nomogram was established to evaluate the accuracy of the final predictive model.Two doctors evaluated the AV-PR distance.The agreement between the two doctors was analyzed using intraclass corredation coefficient(ICC),coefficient of variance(CV),and Bland-Altman plots.The accuracy of the relative position of PR to tumor on MRI was evaluated by Kappa test against the findings in surgery.Results BMI and the distance between seminal vesicle/uterus and rectum were significantly associated with PR’s visibility(P<0.05).Uni-and multivariate analyses confirmed that these two were independent factors for PR’s visibility(P<0.05).Nomogram showed that the accuracy of the final predictive model was 78.2%.For the agreement of AV-PR distance between the two doctors,ICC and CV were 0.822,4.74%,respectively.Bland-Altman plots showed a bias of-0.024 with limits of agreement between-1.326 and 1.279.Compared with findings in surgery,the relative position of PR to tumor on MRI showed good accuracy with a Cohen’s kappa of 0.759.Conclusion BMI and the distance between seminal vesicle/uterus and rectum were factors influencing PR’s visibility on sagittal T2 WI.Measuring AV-PR dis
作者
张绍婷
沈浮
陆建平
高显华
王颢
Zhang Shaoting;Shen Fu;Lu Jianping;Gao Xianhua;Wang Hao(Department of Medical Imaging,Changhai Hospital,Naval Medical University,Shanghai 200433,China;Department of Anorectal Surgery,Changhai Hospital,Naval Medical University,Shanghai 200433,China)
出处
《结直肠肛门外科》
2021年第2期116-121,共6页
Journal of Colorectal & Anal Surgery
基金
海军军医大学青年启动基金(2018QN05)。
关键词
直肠癌
腹膜返折
MRI
rectal cancer
peritoneal reflection
magnetic resonance imaging
