多参数MRI联合外周血细胞参数对直肠癌 淋巴结转移风险的评估

Multiparameter MRI Combined with Peripheral Blood Cell Parameters for Assessing Risk of Lymph Node Metastasis in Rectal Cancer

摘要: 目的：探讨体素内不相干运动(intravoxel incoherent motion, IVIM)、魔镜成像(mDixon‐Quant)技术联合血细胞参数在评估直肠癌淋巴结转移状态中的价值。方法：回顾性分析68例经病理证实为直肠癌患者的临床及影像资料，根据病理结果将患者分为转移阳性组和转移阴性组。测量直肠肿瘤的IVIM参数(D值、D^*值、f值)、mDixon-Quant参数(FF值、R2^*值、T2^*值)。收集血常规数据并计算各项血细胞参数比值。采用组内相关系数(intraclass correlation coefficient, ICC)评估观察者一致性，使用独立样本t检验、Mann-Whitney U检验参数间差异，通过受试者工作特征(receiver operating characteristic, ROC)曲线分析各参数及联合模型诊断淋巴结转移的效能。结果：淋巴结转移阳性组R2^*、FF值、f值、单核细胞/淋巴细胞值(monocyte to lymphocyte ratio, MLR)及全身炎症反应指数(systemic inflammatory response index, SIRI)显著高于阴性组，D值显著低于阴性组(P < 0.05)。ROC分析显示，影像学联合参数(R2^* + FF + f + D)的曲线下面积(area under the curve, AUC)为0.870，联合血细胞参数(R2^* + FF + f + D + MLR + SIRI)的AUC提升至0.887，显著优于单一参数(P < 0.05)。结论：IVIM与mDixon-Quant定量参数联合血细胞参数可显著提高术前评估直肠癌淋巴结转移的诊断效能，为临床制定个体化治疗方案提供重要影像学依据。

Abstract: Objective: To investigate the value of intravoxel incoherent motion (IVIM) and mDixon-Quant multiparameter magnetic resonance imaging (MRI) combined with blood cell parameters in evaluating lymph node metastasis (LNM) in rectal cancer. Methods: Clinical and imaging data of 68 patients with pathologically confirmed rectal cancer were retrospectively analyzed. Based on postoperative pathology, patients were divided into LNM-positive and LNM-negative groups. IVIM parameters (D, D^*, f) and mDixon-Quant parameters (FF, R2^*, T2^*) of the rectal tumors were measured. Peripheral blood cell counts were collected to calculate inflammatory ratios. Intraclass correlation coefficient (ICC) was used to assess interobserver consistency. Independent sample t-test or Mann-Whitney U test was applied to compare differences between groups. The diagnostic efficacy of individual parameters and combined models for LNM was evaluated using receiver operating characteristic (ROC) curve analysis. Results: The LNM-positive group showed significantly higher R2^*, FF, f, monocyte-to-lymphocyte ratio (MLR), and systemic inflammatory response index (SIRI), and lower D values compared to the LNM-negative group (P < 0.05). ROC analysis revealed that the combined imaging parameters (R2^* + FF + f + D) achieved an area under the curve (AUC) of 0.870, while the model combining imaging and blood cell parameters (R2^* + FF + f + D + MLR + SIRI) further improved the AUC to 0.887, significantly outperforming any single parameter (P < 0.05). Conclusion: The combination of IVIM and mDixon-Quant parameters with blood cell indices significantly enhances the diagnostic performance for preoperative prediction of LNM in rectal cancer, providing valuable imaging support for individualized clinical decision-making.