Kou Peisi, Lin Liangjie, Li Ying, Qin Hui, Zhang Kun, Zhang Wenhua, Li Juan, Zhang Yong, Cheng Jingliang
Department of Magnetic Resonance Imaging (MRI), The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
Clinical and Technical Support, Philips Healthcare, Beijing, China.
Front Oncol. 2025 Feb 3;15:1535271. doi: 10.3389/fonc.2025.1535271. eCollection 2025.
To explore the value of cellular microstructural mapping by IMPULSED (imaging microstructural parameters using limited spectrally edited diffusion) method in evaluating the histological type and prognostic factors of rectal lesions.
Sixty-six patients with rectal lesions were enrolled in this study. All subjects underwent MRI scans including conventional diffusion weighted imaging (DWI) and the IMPULSED MRI scans of oscillating gradient spin-echo (OGSE) and pulse gradient spin-echo (PGSE) sequences. Parameters including mean cell diameter (d), intracellular fraction (v), extracellular diffusivity (d), cellularity, and apparent diffusion coefficient (ADC) values (ADC, ADC, ADC, and ADC of conventional DWI) were measured in different histopathologic types, grades, stages, and structure invasion statuses. The receiver operating characteristic (ROC) curve analysis was used to evaluate diagnostic power. The sensitivity, specificity, and the corresponding area under the curves (AUCs) were calculated.
Our preliminary results illustrated that malignant lesion showed higher v and cellularity ([0.2867 ± 0.0697] vs. [0.1856 ± 0.1011], [2.3508 ± 0.6055] vs. [1.2716 ± 0.4574], all <0.05), lower d and ADC values (ADC, ADC, and ADC of conventional DWI) compared to benign lesion ([2.1637 ± 0.3303 μm/ms] vs. [2.5595 ± 0.5085 μm/ms], [0.9238 (0.7959, 1.0741) ×10 mm/s] vs. [1.3373 ± 0.3902×10 mm/s], [1.3204 ± 0.2342×10 mm/s] vs. [1.8029 ± 0.3119×10 mm/s], [0.7400 (0.6750, 0.8375) ×10 mm/s] vs. [1.0550 ± 1.1191×10 mm/s], all <0.05), while no significant difference was seen for d. V and cellularity of rectal common adenocarcinoma (AC) were significantly higher than those of rectal mucinous adenocarcinoma (MC) ([0.2994 ± 0.0626] vs. [0.2028 ± 0.0571], [2.4579 ± 0.5553] vs. [1.6412 ± 0.4347], all <0.05), while dex and ADC values (ADC, ADC, ADC, and ADC of conventional DWI) were lower in AC ([2.1189 ± 0.3187 μm/ms] vs. [2.4609 ± 0.2534 μm/ms], [0.8996 ± 0.1583×10 mm/s] vs. [1.2072 ± 0.2326×10 mm/s], [1.2714 ± 0.1916×10 mm/s] vs. [1.6451 ± 0.2420×10 mm/s], [1.8963 (1.6481, 2.1138) ×10 mm/s] vs. [2.3104 ± 0.3851×10 mm/s], [0.7341 ± 0.8872×10 mm/s] vs. [1.1410 ± 0.1840×10 mm/s], all <0.05). In AC group, the d had significant difference between negative and positive tumor budding (TB) ([13.2590 ± 1.3255 μm] vs. [14.3014 ± 1.1830 μm], <0.05). No significant difference of d, v, d, cellularity or ADC values was observed in AC with different grade, T stage, N stage, perineural and lymphovascular invasion (all >0.05). The ROC curves showed that the area under the curves (AUCs) of v, d, cellularity, and ADC values (ADC, ADC, and ADC of conventional DWI) for distinguishing malignant and benign lesion were 0.803, 0.757, 0.948, 0.807, 0.908 and 0.905, respectively. The AUCs of v, d, cellularity, and ADC values (ADC, ADC, ADC, and ADC of conventional DWI) in distinguishing AC from MC were 0.887, 0.802, 0.906, 0.896, 0.896, 0.781 and 0.991, respectively. The AUC of the d for evaluating TB status was 0.726. The AUC of ADC from conventional DWI for evaluating WHO grade was 0.739.
Cellular microstructural mapping by the IMPULSED method has great potential in preoperative evaluation of rectal lesions. It could be helpful in differentiating malignant and benign lesions, distinguishing AC from MC, and in predicting the TB status.
探讨采用IMPULSED（利用有限频谱编辑扩散成像微观结构参数）方法进行细胞微观结构成像在评估直肠病变组织学类型及预后因素中的价值。
本研究纳入66例直肠病变患者。所有受试者均接受MRI扫描，包括常规扩散加权成像（DWI）以及振荡梯度自旋回波（OGSE）和脉冲梯度自旋回波（PGSE）序列的IMPULSED MRI扫描。在不同组织病理学类型、分级、分期及结构侵犯状态下测量平均细胞直径（d）、细胞内分数（v）、细胞外扩散率（d）、细胞密度及表观扩散系数（ADC）值（常规DWI的ADC、ADC、ADC和ADC）。采用受试者工作特征（ROC）曲线分析评估诊断效能，计算敏感性、特异性及相应曲线下面积（AUC）。
初步结果表明，与良性病变相比，恶性病变的v和细胞密度更高（[0.2867±0.0697]对[0.1856±0.1011]，[2.3508±0.6055]对[1.2716±0.4574]，均P<0.05），d和ADC值（常规DWI的ADC、ADC和ADC）更低（[2.1637±0.3303μm/ms]对[2.5595±0.5085μm/ms]，[0.9238(0.7959,1.0741)×10⁻³mm²/s]对[1.3373±0.3902×10⁻³mm²/s]，[1.3204±0.2342×10⁻³mm²/s]对[1.8029±0.3119×10⁻³mm²/s]，[0.7400(0.6750,0.8375)×10⁻³mm²/s]对[1.0550±1.1191×10⁻³mm²/s]，均P<0.05），而d无显著差异。直肠普通腺癌（AC）的v和细胞密度显著高于直肠黏液腺癌（MC）（[0.2994±0.0626]对[0.2028±0.0571]，[2.4579±0.5553]对[1.6412±0.4347]，均P<0.05），而AC的dex和ADC值（常规DWI的ADC、ADC、ADC和ADC）更低（[2.1189±0.3187μm/ms]对[2.4609±0.2534μm/ms]，[0.8996±0.1583×10⁻³mm²/s]对[1.2072±0.2326×10⁻³mm²/s]，[1.2714±0.1916×10⁻³mm²/s]对[1.6451±0.2420×10⁻³mm²/s]，[1.8963(1.6481,2.1138)×10⁻³mm²/s]对[2.3104±0.3851×10⁻³mm²/s]，[0.7341±0.8872×10⁻³mm²/s]对[1.1410±0.1840×10⁻³mm²/s]，均P<0.05）。在AC组中，肿瘤芽生（TB）阴性和阳性之间的d有显著差异（[13.2590±1.3255μm]对[14.3014±1.1830μm]，P<0.05）。不同分级、T分期、N分期、神经周围及血管侵犯的AC中，d、v、d、细胞密度或ADC值均无显著差异（均P>0.05）。ROC曲线显示用于区分恶性和良性病变的v、d、细胞密度及ADC值（常规DWI的ADC、ADC和ADC）的曲线下面积（AUC）分别为0.803、0.757、0.948、0.807、0.908和0.905。区分AC与MC的v、d、细胞密度及ADC值（常规DWI的ADC、ADC、ADC和ADC）的AUC分别为0.887、0.802、0.906、0.896、0.896、0.781和0.991。评估TB状态的d的AUC为0.726。评估WHO分级的常规DWI的ADC的AUC为0.739。
IMPULSED方法进行细胞微观结构成像在直肠病变术前评估中具有很大潜力，有助于鉴别恶性和良性病变、区分AC与MC以及预测TB状态。
