| Objectives By comparing the results of endorectal ultrasonography with head scanning probe and MRI in the diagnosis of rectal occupying lesions,and evaluated the clinical significance of the two imaging diagnostic methods alone and in combination to provide a scientific basis for clinical selection of diagnostic imaging methods with high diagnostic efficiency.Methods Independent blind method was used to detect the occupying lesions with clinical symptoms and transrectal examination and conforms to the inclusion and exclusion criteria in the same period with endorectal ultrasonography with head scanning probe and MRI pelvic scan.Ultrasonography was performed by the director of the Department of Ultrasound.The results of the MRI examination were diagnosed by the senior physician in the Nuclear Magnetic Surgery Department.The pathological diagnosis was performed by the Department of Pathology in our hospital.The graduate student was responsible for data collection and organization.Data use Excel worksheet to establish a database,SPSS24.0 statistical software for statistical analysis.Chi-square test and consistency analysis were used for counting data.Pathology was used as the gold standard for diagnostic tests.The compliance rate,sensitivity,specificity,Youden's index,and kappa value of each index were calculated and compared using ROC curves.Joint trials determine the type of joint trial(parallel or serial test)based on the sensitivity and specificity of each index.Results 1 From January 2015 to February 2018,212 patients were hospitalized for rectal space-occupying lesions in our hospital.32 patients refused treatment or transferred to hospital.47 patients with rectal cancer were treated with preoperative neoadjuvant radiochemotherapy.131 patients were eventually obtained.Complete information on patients with rectal space-occupying lesions.2 In the benign and malignant diagnosis of rectal masses,the coincidence rate of end-sweep intraluminal ultrasound and pathological diagnosis was 94.7%,of which the sensitivity and specificity were all over 94%;the sensitivity of MRI diagnosis knot was 98%,but the specificity was only 67%.The coincidence rate of MRI was slightly higher than that of end-scan intraluminal ultrasound;the area under the ROC curve for the diagnosis of rectal mass with end-sweep intraluminal ultrasound reached 0.939 greater than 0.9,and the area under the ROC curve of MRI was 0.822.Therefore,endoscopic ultrasound in the diagnosis of benign masses of rectal masses is of higher value than MRI.3 In the judgment of T staging of rectal cancer,the total coincidence rate of preoperative T staging and postoperative pathological T staging judgement by end-scanning intraluminal ultrasound was 75%,and the sensitivity to T1-2 and T3 judgments reached more than 80%.The kappa coefficient was between 0.4 and 0.75,and there was no significant difference in end-sweep intraluminal ultrasound and pathological diagnosis,indicating a very high consistency between end-sweep intraluminal ultrasound and pathological diagnosis;MRI and postoperative pathology The total coincidence rate of T stage judgment was 60%,the sensitivity to T1-2 stage judgment was 56%,the specificity to T3 stage judgment was 50%,and the kappa coefficient was less than 0.4,indicating the consistency between MRI and pathological diagnosis.difference.It can be seen that the sensitivity and coincidence rate of the end-scan endoscopic ultrasound for judging T1-2,T3 period are greater than MRI.4 In the N stage staging of rectal cancer,the overall agreement rate of preoperative N stage staging and postoperative pathological N staging judgment by end-scanning intraluminal ultrasound was 59%.The sensitivity of end-scan ultrasound in judging the N0 phase was higher than that of N1-2 phase,indicating that endoscopic ultrasound was superior to the diagnosis of lymph node metastasis in the diagnosis of lymph node metastasis;the overall coincidence rate of MRI and postoperative pathological N staging was judged.At 31%,the sensitivity of MRI to N staging was very low,only 22%;kappa coefficient was negative,indicating that the consistency between MRI and pathological diagnosis was very poor.5 In order to improve the specificity of MRI in the diagnosis of benign and malignant colorectal masses and reduce the rate of misdiagnosis,a series test of end-scanning intracavity ultrasound and MRI was performed.The sensitivity was raised to 100%,and the specificity was improved to 97%.The Kappa value was 0.84.The consistency with pathological diagnosis is extremely high.The results of judging the T1-2 period of rectal cancer by end-scanning intraluminal ultrasound and MRI in parallel and in series showed that although the end-scanning intracavity ultrasound and MRI were connected in parallel,the sensitivity increased to 88%.The specificity of end-sweep intraluminal ultrasound in tandem with MRI increased to 94%.However,the overall diagnostic value of a parallel or series test is no better than that of end-scanning intracavity sonography.The results of judging the T3 phase of rectal cancer by endscanning intraluminal ultrasound and MRI in parallel and in series showed that the sensitivity of the end-scanning intracavity ultrasound and MRI in parallel increased to 95%.The sensitivity of the end-scan endoscopic ultrasound and MRI in series was 93%,and the specificity was reduced to 47%.Although the reliability and reality of the parallel test are not as high as those of end-scanning intracavity ultrasound,the sensitivity is high.Therefore,in order to prevent misdiagnosis in the judgment of rectal cancer in T3 stage,two imaging methods can be selected in parallel.Conclusions 1 Endorectal ultrasonography with head scanning probe is superior to MRI in diagnosing benign and malignant lesions of rectum.2 Endorectal ultrasonography with head scanning probe and MRI serial test have higher diagnostic value for rectal spaceoccupying lesions.3 Endorectal ultrasonography with head scanning probe is superior to MRI in judging the T1 and T2 rectal cancer.4 Endorectal ultrasonography with head scanning probe in the assessment of T3 rectal cancer may be more accurate than MRI.5 Endorectal ultrasonography with head scanning probe and MRI for the diagnosis of T4 rectal cancer need to be improved.6 Judgment of T3 rectal cancer can try to choose endorectal ultrasonography with head scanning probe and MRI parallel test. |
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