Purpose: To assess the use of quantitative diffusion-weighted MRI (DW-MRI) as a diagnostic imaging biomarker in differentiating between benign colon adenoma, early, and advanced cancer of the colon, as well as predicting lymph node involvement, and finally comparing mucinous-producing colon cancer with adenomas and non-mucinous colon cancer. Method: Patients with a confirmed tumor on colonoscopy were eligible for inclusion in this study. Using a 3.0 Tesla MRI machine, the main tumor mean apparent diffusion coefficient (mADC) was obtained. Surgically resected tumor specimens served as an endpoint, except in mucinous colon cancers, which were classified based on T2 images. Results: A total of 152 patients were included in the study population. The mean age was 71 years. A statistically significant mADC mean difference of −282 × 10−6mm2/s [−419–−144 95% CI,p< 0.001] was found between colon adenomas and early colon cancer, with an AUC of 0.80 [0.68–0.93 95% CI] and an optimal cut off value of 1018 × 10−6mm2/s. Only a small statistically significant difference (p= 0.039) in mADC was found between benign tumors and mucinous colon cancer. We found no statistical difference in mADC mean values between early and advanced colon cancer, and between colon cancer with and without lymph node involvement. Conclusion: Quantitative DW-MRI is potentially useful for determining whether a colonic tumor is benign or malignant. Mucinous colon cancer shows less diffusion restriction when compared to non-mucinous colon cancer, a potential pitfall.
目的：评估定量弥散加权磁共振成像（DW-MRI）作为诊断性影像学生物标志物在鉴别结肠良性腺瘤、早期结肠癌与进展期结肠癌、预测淋巴结转移方面的价值，并比较黏液性结肠癌与腺瘤及非黏液性结肠癌的差异。方法：本研究纳入经结肠镜确诊的肿瘤患者。使用3.0特斯拉磁共振设备获取肿瘤主体平均表观扩散系数（mADC）。除黏液性结肠癌依据T2加权图像分类外，其余均以手术切除标本为最终诊断标准。结果：研究共纳入152例患者，平均年龄71岁。结肠腺瘤与早期结肠癌的mADC均值存在显著统计学差异（-282×10⁻⁶mm²/s，95%置信区间[-419至-144]，p<0.001），受试者工作特征曲线下面积为0.80（95%置信区间[0.68-0.93]），最佳截断值为1018×10⁻⁶mm²/s。良性肿瘤与黏液性结肠癌的mADC仅存在微小统计学差异（p=0.039）。早期与进展期结肠癌之间、有无淋巴结转移的结肠癌之间，mADC均值均未发现统计学差异。结论：定量DW-MRI对判断结肠肿瘤良恶性具有潜在应用价值。需注意黏液性结肠癌较非黏液性结肠癌弥散受限程度更低，可能造成诊断误区。
Diffusion-Weighted MRI as a Quantitative Imaging Biomarker in Colon Tumors
肿瘤(癌症)患者之家