The Application Of Intravoxel Incoherent Motion Diffusion Weighted Imaging And Dynamic Contranst Enhanced Magnetic Resonance Imaging In The Diagnosis Of Rectal Cancer With 3.0T MR

Part one. Study on the relationship between incoherent motion diffusion weighted imaging parameters and clinicopathological, prognostic factors of rectal cancer with 3.0T MRPurpose: The aim of this study was to investigate the relationship between intravoxel incoherent motion diffusion weighed imaging parameters and clinicopathological, prognostic factors(T staging, N staging, M staging and clinical staging) of rectal cancer with 3.0T MR.Materials and Methods: Collection a total of 50 patients who had proven to be adenocarcinoma of rectum and who had rectal MRI(including IVIM-DWI sequence) and clinical findings. T staging was divided into no breakthrough group(T1 stage, T2 stage) and breakthrough group(T3 stage, T4 stage), according to whether the tumour broke through the muscularis propria. N staging was divided into N0 group and N+ group, according to whether there was a lymph node metastasis in the tumour. M staging was divided into M0 group and M1 group, according to whether there was a distant metastasis in the tumour. The tumours were divided into I group, II group, III group and IV group, according to the clinical staging. The D, f, D* and ADC values of rectal cancer and normal rectal wall were measured and compared between tumour and normal rectal wall, different T, N, M, clinical staging groups. The relationship between IVIM-DWI parameters, ADC values and T staging, N staging, M staging, clinical staging of rectal adenocarcinoma was analysed.Results: In 50 cases of rectal adenocarcinoma, there were 2 cases of mucinous adenocarcinoma, 2 cases of poorly differentiated adenocarcinoma, 46 cases of moderately differentiated adenocarcinoma, 8 cases of T1 stage, 11 cases of T2 stage, 23 cases of T3 stage, 8 cases of T4 stage, 30 cases of N0 stage, 20 cases of N+ stage, 45 cases of M0 stage, 5 cases of M1 stage, 16 cases of I stage, 12 cases of II stage, 17 cases of III stage, 5 cases of IV stage. The D, D*, f and ADC values of rectal cancer were(0.822 ± 0.201) ×10-3mm2/s,(12.67 ± 3.377) ×10-3mm2/s,(26.10 ± 4.018) %,(0.914 ± 0.135) ×10-3mm2/s, respectively. The D, D*, f and ADC values of normal rectal wall were(1.128 ± 0.205) ×10-3mm2/s,(13.86 ± 4.241) ×10-3mm2/s,(33.68 ± 5.141) %,(1.306 ± 0.232) ×10-3mm2/s, respectively. All the parameter values of rectal cancer were lower than those of normal rectal wall, the difference of D、f and ADC values were statistically significant(t =-8.756,-8.756,-11.935, P < 0.05). The D, D*, f and ADC values of no breakthrough group were(0.920 ± 0.153) ×10-3mm2/s,(12.95 ± 3.141) ×10-3mm2/s,(27.68 ± 3.284) %,(0.945 ± 0.088) ×10-3mm2/s, respectively. The D, D*, f and ADC values of breakthrough group were(0.762 ± 0.206) ×10-3mm2/s,(12.49 ± 3.553) ×10-3mm2/s,(25.13 ± 4.166) %,(0.896 ± 0.156) ×10-3mm2/s, respectively. All the parameter values of breakthrough group were lower than those of no breakthrough group, the difference of D, f values were statistically significant(t = 2.887, 2.264, P < 0.05). The D, D*, f and ADC values of N0 group were(0.880 ± 0.149) ×10-3mm2/s,(13.04 ± 3.257) ×10-3mm2/s,(26.65 ± 3.866) %,(0.927 ± 0.120) ×10-3mm2/s, respectively. The D, D*, f and ADC values of N+ group were(0.735 ± 0.240) ×10-3mm2/s,(12.11 ± 3.561) ×10-3mm2/s,(25.28 ± 4.199) %,(0.895 ± 0.157) ×10-3mm2/s, respectively. All the parameter values of N+ group were lower than those of N0 group, the difference of D values was statistically significant(t = 2.638, P = 0.011). The D, D*, f and ADC values of M0 group were(0.819 ± 0.208) ×10-3mm2/s,(12.65 ± 3.386) ×10-3mm2/s,(26.19 ± 4.153) %,(0.912 ± 0.138) ×10-3mm2/s, respectively. The D, D*, f and ADC values of M1 group were(0.854 ± 0.136) ×10-3mm2/s,(12.80 ± 3.682) ×10-3mm2/s,(25.28 ± 2.676) %,(0.939 ± 0.119) ×10-3mm2/s, respectively. There was no significant difference between M0 group and M1 group for all the parameters(P > 0.05). The D, D*, f and ADC values of I group were(0.914 ± 0.165) ×10-3mm2/s,(12.93 ± 3.382) ×10-3mm2/s,(27.70 ± 3.387) %,(0.945 ± 0.096) ×10-3mm2/s, respectively. The D, D*, f and ADC values of II group were(0.852 ± 0.130) ×10-3mm2/s,(12.75 ± 3.046) ×10-3mm2/s,(25.72 ± 4.413) %,(0.905 ± 0.153) ×10-3mm2/s, respectively. The D, D*, f and ADC values of III group were(0.705 ± 0.242) ×10-3mm2/s,(12.32 ± 3.772) ×10-3mm2/s,(25.11 ± 4.428) %,(0.885 ± 0.160) ×10-3mm2/s, respectively. The D, D*, f and ADC values of IV group were(0.854 ± 0.136) ×10-3mm2/s,(12.80 ± 3.682) ×10-3mm2/s,(25.28 ± 2.676) %,(0.939 ± 0.119) ×10-3mm2/s, respectively. The values of the parameters in different clinical stages of tumour were decreased from I to III stage, the difference of D values in different clinical stages was statistically significant(F = 3.650, P = 0.019), LSD Duncan test showed that the difference of D values in I stage and III stage, II stage and III stage were statistically significant(P = 0.002, 0.042).Conclusion: The IVIM parameters, ADC values can distinguish rectal cancer and normal rectal wall. The IVIM parameters can estimate clinicopathological and prognostic features of rectal cancer in a non-invasive way. Eliminating microcirculation perfusion the D values may be more accurate and true to reflect the clinicopathological and prognostic features of rectal cancer than the ADC values.Part two. Study on the relationship between dynamic contranst enhanced magnetic resonance imaging parameters and clinicopathological, prognostic factors of rectal cancer with 3.0T MRPurpose: The aim of this study was to investigate the relationship between dynamic contranst enhanced magnetic resonance imaging parameters and clinicopathological, prognostic factors(T staging, N staging, M staging and clinical staging) of rectal cancer with 3.0T MR.Materials and Methods: Collection a total of 48 patients who had proven to be adenocarcinoma of rectum and who had rectal MRI(including DCE sequence) and clinical findings. T staging was divided into no breakthrough group(T1 stage, T2 stage) and breakthrough group(T3 stage, T4 stage), according to whether the tumour broke through the muscularis propria. N staging was divided into N0 group and N+ group, according to whether there was a lymph node metastasis in the tumour. M staging was divided into M0 group and M1 group, according to whether there was a distant metastasis in the tumour. The tumours were divided into I group, II group, III group and IV group, according to the clinical staging. The Ktrans, Kep and Ve values of rectal cancer were measured and compared between different T, N, M, clinical staging groups. The relationship between DCE parameters and T staging, N staging, M staging, clinical staging of rectal adenocarcinoma was analysed.Results: In 48 cases of rectal adenocarcinoma, there were 2 cases of mucinous adenocarcinoma, 2 cases of poorly differentiated adenocarcinoma, 44 cases of moderately differentiated adenocarcinoma, 8 cases of T1 stage, 11 cases of T2 stage, 22 cases of T3 stage, 7 cases of T4 stage, 28 cases of N0 stage, 20 cases of N+ stage, 43 cases of M0 stage, 5 cases of M1 stage, 16 cases of I stage, 10 cases of II stage, 17 cases of III stage, 5 cases of IV stage. The Ktrans, Kep and Ve values of no breakthrough group were(0.228 ± 0.044)/min,(0.926 ± 0.256)/min, 0.269 ± 0.081, respectively. The Ktrans, Kep and Ve values of breakthrough group were(0.301 ± 0.065)/min,(1.127 ± 0.324)/min, 0.294 ± 0.103, respectively. The Ktrans, Kep and Ve values of breakthrough group were higher than those of no breakthrough group, the difference of Ktrans, Kep values were statistically significant(t =-4.281,-2.270, P < 0.05). The Ktrans, Kep and Ve values of N0 group were(0.254 ± 0.060) /min,(0.976 ± 0.265)/min, 0.275 ± 0.059, respectively. The Ktrans, Kep and Ve values of N+ group were(0.297 ± 0.071)/min,(1.147 ± 0.351)/min, 0.297 ± 0.130, respectively. All the parameter values of N+ group were higher than those of N0 group, the difference of Ktrans value was statistically significant(t =-2.292, P = 0.027). The Ktrans, Kep and Ve values of M0 group were(0.266 ± 0.066)/min,(1.031 ± 0.296)/min, 0.280 ± 0.090, respectively. The Ktrans, Kep and Ve values of M1 group were(0.326 ± 0.065)/min,(1.185 ± 0.447)/min, 0.315 ± 0.134, respectively. There was no significant difference between M0 group and M1 group for all the parameters(P > 0.05). The Ktrans, Kep and Ve values of I group were(0.229 ± 0.038)/min,(0.919 ± 0.253)/min, 0.268 ± 0.061, respectively. The Ktrans, Kep and Ve values of II group were(0.285 ± 0.070)/min,(1.048 ± 0.292)/min, 0.286 ± 0.062, respectively. The Ktrans, Kep and Ve values of III group were(0.289 ± 0.072)/min,(1.127 ± 0.292)/min, 0.289 ± 0.125, respectively. The Ktrans, Kep and Ve values of IV group were(0.326 ± 0.065)/min,(1.185 ± 0.448)/min, 0.315 ± 0.134, respectively. The values of the parameters in different clinical stages of tumor were increased from I to IV stage, the difference of Ktrans values in different clinical stages was statistically significant(F = 4.486, P = 0.008), LSD Duncan test showed that the difference of Ktrans values in I stage and II stage, I stage and III stage, I stage and IV stage were statistically significant(P = 0.029, 0.008, 0.003).Conclusion: The DCE parameters can estimate clinicopathological and prognostic features of rectal cancer in a non-invasive way.