Zhou Mi, Chen Mengyuan, Luo Mingfang, Chen Meining, Huang Hongyun
Department of Radiology, Sichuan Provincial Orthopaedics Hospital, 610041, Chengdu, China.
Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, 610072, Chengdu, China.
Eur Radiol. 2025 Feb;35(2):979-988. doi: 10.1007/s00330-024-11025-7. Epub 2024 Aug 14.
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.
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.
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.
The DKI parameters may be used as imaging biomarkers to assess pathological prognostic factors of rectal cancer before surgery.
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.
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.
探讨扩散加权成像（DWI）、体素内不相干运动（IVIM）和扩散峰度成像（DKI）在评估直肠癌患者病理预后因素中的应用。
本前瞻性研究纳入了162例计划接受根治性手术的患者（105例男性；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）。获取DWI、IVIM和DKI参数，并使用单变量和多变量逻辑回归分析其与预后因素的相关性。采用受试者工作特征（ROC）曲线分析评估其评估价值。
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）与肿瘤分化较差独立相关。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LNM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评估组织学分化的ROC曲线下面积（AUC）显著高于ADC（0.771对0.638，p=0.035）。MK评估LNM阳性的AUC高于f（0.770对0.656，p=0.048）。在评估EMVI方面，MK与MD联合的AUC（0.790）在f（0.663）、MK（0.779）、MD（0.617）和ADC（0.610）中最高。
DKI参数可作为术前评估直肠癌病理预后因素的影像学生物标志物。
扩散峰度成像（DKI）参数，尤其是平均峰度（MK），是评估直肠癌组织学分化、淋巴结转移和壁外血管侵犯的有前景的生物标志物。这些发现提示了DKI在直肠癌术前评估中的潜力。
在评估可切除直肠癌的组织学分化方面，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率在评估壁外血管侵犯方面显示出更高的准确性。
