经直肠超声造影联合磁共振成像在中低位直肠癌T分期及治疗决策中的应用价值

doi:10.16150/j.1671-2870.2025.03.008

摘要/Abstract

摘要：

目的：探讨经直肠超声造影（contrast-enhanced ultrasound，CEUS）联合磁共振成像（magnetic resonance imaging，MRI）在中低位直肠癌T分期中的应用价值，为多学科综合诊疗（multi-disciplinary treatment，MDT）提供精准依据。方法：回顾性分析2023年4月至2025年2月期间本院连续收治的80例中低位直肠癌患者资料。所有患者在活检或手术前1周内依次完成经直肠超声（transrectal ultrasound，TRUS）、CEUS及3.0T MRI检查。以术后病理结果为金标准，分别计算单独及联合检查诊断中低位直肠癌T分期的效能。结果：联合检查对T₁期直肠癌的诊断灵敏度、特异度、阳性预测值、阴性预测值分别为87.5%、99%、99.9%、96.7%，联合检查对T₂期直肠癌的诊断灵敏度、特异度、阳性预测值、阴性预测值分别91.3%、96.3%、91.3%、96.3%，联合检查对T₃期直肠癌的诊断灵敏度、特异度、阳性预测值、阴性预测值分别为93.5%、97.8%、96.7%、95.7%，联合检查对T₄期直肠癌的诊断灵敏度、特异度、阳性预测值、阴性预测值分别为90%、98.5%、90%、98.5%。联合检查对T₁-T₄期直肠癌的诊断准确率分别为97.5%、97.5%、96.25%和98.7%，单独CEUS检查对T₁-T₄期直肠癌的诊断准确率分别为87.5%、86.96%、80.65%和80%，单独MRI检查对T₁-T₄期直肠癌的诊断准确率分别为81.25%、78.26%、90.32%和90%，联合检查准确率显著高于CEUS或MRI的单一检查（P<0.05）。联合检查与病理分期一致性良好（Kappa值=0.877，P<0.05）。CEUS联合MRI检查后，诊断模型受试者操作特征曲线下面积（area under the curve，AUC）跃升至0.85，显著超越单一检查手段（CEUS AUC=0.75，MRI AUC=0.758）。另发现CEUS的T₁-T₂期直肠癌表现出不同程度的均匀增强，CEUS联合MRI诊断T₁-T₂期直肠癌的特异度达到96.3%以上，CEUS于门脉期的低增强对T₃期及以上直肠癌诊断特异度高达95.5%。结论：CEUS联合MRI在直肠癌T分期诊断中具有明显优势，尤其T₁及T₂期较单一检查优势显著，联合检查的准确率可达97.5%及97.5%，其中特异度可达99%及96.3%，可用于排除非肿瘤性病变。

关键词: 多模态影像, 经直肠超声造影, 磁共振成像, 直肠癌T分期, 外科治疗

Abstract:

Objective To explore the application value of contrast-enhanced ultrasound (CEUS) combined with magnetic resonance imaging (MRI) in T staging of middle and low rectal cancer, providing an accurate basis for multidisciplinary treatment (MDT). Method AA retrospective analysis was conducted on the case data of 80 consecutive patients with middle and low rectal cancer admitted to the hospital from April 2023 to February 2025. All patients underwent transrectal ultrasound (TRUS), CEUS, and 3.0T MRI examinations within one week before biopsy or surgery. Using postoperative pathological results as the gold standard, the diagnostic performance of single and combined examinations in diagno-sing T staging of low rectal cancer was calculated separately. Result The combined examination for T₁ rectal cancer showed a sensitivity of 87.5%, specificity of 99%, positive predictive value of 99.9%, and negative predictive value of 96.7%. For T₂ rectal cancer, the sensitivity, specificity, positive predictive value, and negative predictive value were 91.3%, 96.3%, 91.3%, and 96.3%, respectively. For T₃ rectal cancer, these values were 93.5%, 97.8%, 96.7%, and 95.7%, respectively. For T₄rectal cancer, these values were 90%, 98.5%, 90%, and 98.5%, respectively. The diagnostic accuracy of the combined examination for T₁-T₄ rectal cancer was 97.5%, 97.5%, 96.25%, and 98.7%, respectively. The diagnostic accuracy of CEUS examination alone for T₁-T₄stages was 87.5%, 86.96%, 80.65%, and 80%, respectively. The diagnostic accuracy of MRI examination alone for T₁-T₄ stages was 81.25%, 78.26%, 90.32%, and 90%, respectively. The accuracy of the combined examination was significantly higher than that of CEUS or MRI examination alone (P<0.05). The consistency between the combined examination and pathological staging was good (Kappa value=0.877, P<0.05). After CEUS combined with MRI examination, the area under the curve (AUC) of the receiver operating characteristic curve of the diagnostic model rose to 0.85, significantly exceeding that of single examination methods(CEUS AUC=0.75, MRI AUC=0.758). Additionally, it was found that T₁-T₂ rectal cancer showed varying degrees of uniform enhancement on CEUS, and the specificity of CEUS combined with MRI in diagnosing T₁-T₂ rectal cancer reached over 96.3%. The low enhancement observed on CEUS in the portal phase achieved a high specificity of 95.5% for diagnosing T₃ and higher-stage tumors. Conclusion CEUS combined with MRI has significant advantages in the diagnosis of T staging of rectal cancer, especially for T₁ and T₂ stages, which have notable superiority over single examination. The accuracy of the combined examination can reach 97.5% and 97.5%, and the specificity can reach 99% and 96.3%, respectively, making it useful for ruling out non-neoplastic lesions.

Key words: Multimodal imaging, Transrectal contrast-enhanced ultrasound, Magnetic resonance imaging, Rectal cancer T staging, Surgical treatment

中图分类号:

赵然, 詹维伟, 李成, 汤海浪, 卜玉莲, 刘坤. 经直肠超声造影联合磁共振成像在中低位直肠癌T分期及治疗决策中的应用价值[J]. 诊断学理论与实践, 2025, 24(03): 293-300.

ZHAO Ran, ZHAN Weiwei, LI Cheng, TANG Hailang, BO Yulian, LIU Kun. Application value of transrectal contrast-enhanced ultrasound combined with magnetic resonance imaging in T staging and treatment decision-making for middle and low rectal cancer[J]. Journal of Diagnostics Concepts & Practice, 2025, 24(03): 293-300.

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Pathologic staging	Inspection method	Sensitivity	Specificity	Positive predictive value	Negative predictive value
T₁	CEUS MRI Joint inspection	0.875 0.813 0.875	0.981 0.990 0.990	0.933 0.999 0.999	0.964 0.948 0.967
T₂	CEUS MRI Joint inspection	0.870 0.783 0.913	0.959 0.926 0.963	0.909 0.818 0.913	0.940 0.909 0.963
T₃	CEUS MRI Joint inspection	0.806 0.903 0.935	0.955 0.952 0.978	0.926 0.933 0.967	0.875 0.930 0.957
T₄	CEUS MRI Joint inspection	0.800 0.900 0.900	0.983 0.983 0.985	0.889 0.900 0.900	0.967 0.983 0.985