磁共振DWI在肺癌脑转移瘤放化疗联合中药治疗早期疗效评价的应用研究

发布时间：2018-01-04 23:06

本文关键词：磁共振DWI在肺癌脑转移瘤放化疗联合中药治疗早期疗效评价的应用研究　出处：《北京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:通过观察肺癌脑转移瘤在放化疗联合中药治疗前、后ADC值的变化,分析病灶治疗有效组与无效组的早期ADC值变化规律,探讨磁共振扩散加权成像(DWI)作为一种早期、无创、可重复的功能学成像方法,通过对治疗早期ADC值检测,来评价肺癌脑转移瘤放化疗联合中药治疗疗效的早期应用价值。方法:收集30例经病理或临床及影像学确诊为肺癌脑转移瘤病人,分别对患者放化疗联合中药治疗前1周,治疗1周期,治疗2周期后进行T1WI平扫、T2WI平扫、T1WI增强MRI和磁共振扩散加权成像(DWI)检查,通过在常规及T1WI增强MRI图像上选择病灶最大层面并测量其最大径,对比治疗前和治疗后2周期肿块体积变化,依照实体瘤的疗效评价标准(RECIST),将其分为有效组与无效组。然后把DWI图像(b=0,1000s/mm2)传送到飞利浦工作站生成ADC图,测量出ADC值,对治疗前有效组与无效组ADC值进行对比,统计学方法采用独立样本t检验,了解治疗前病灶ADC值大小是否对于肺癌脑转移瘤治疗疗效有预测作用。通过公式计算有效组与无效组治疗1周期的ADC变化率:△ADC%=(ADC后-ADC前)/ADC前×100%,对治疗后1周期有效组与无效组△ADC%运用独立样本t检验方法对比分析,了解其是否具有统计学意义。此外,根据不同组别的△ADC%的数据,运用受试者工作特征(ROC)曲线评价治疗1周期△ADC%诊断效能,得到△ADC%最佳阈值。所有数据采用SPSS20.0软件分析。结果:30例患者共计43个肺癌脑转移病灶,治疗前病灶最大直径为(2.78±0.15)cm,治疗1周期后病灶最大直径为(2.69±0.14)cm,病灶治疗前与治疗1周期最大直径比较,差异无统计学意义(t=1.725,P=0.092),提示肺癌转移瘤病灶在综合治疗早期体积变化无统计学差异。在治疗后2周期后,病灶最大直径为(2.24±0.13)cm,与治疗前病灶最大直径为(2.78±0.15)cm比较,差异有统计学意义(t=1.420,P=0.000),有效22例(有效组),无效21例(无效组),提示病灶在治疗后2个周期后体积变化有统计学差异。肺癌脑转移瘤治疗前一周内有效组的平均ADC值(0.97±0.05)×10-3mm2/s,而无效组平均ADC值为(1.17±0.06)×10-3mm2/s,有效组与无效组之间无统计学差异(t=2.42,p=0.083),说明治疗前病灶ADC值不能有效预测治疗反应。有效组治疗前1周期平均ADC值(0.97±0.05)×10-3mm2/s,治疗1周期后平均ADC值(1.21±0.04)×10-10-3mm2/s,两者差异有统计学意义(t=-8.76,p=0.000)。说明有效组在治疗1周期后ADC值明显增高。而治疗无效组治疗前1周期平均ADC值(1.17±0.07)×10-3mm2/s,治疗后1周期后平均ADC值(1.20±0.08)×10-3mm2/s,两者差异无统计学意义(t=-0.98,p=0.33),说明无效组在治疗1周期后病灶ADC可能增大或者减小。根据公式计算出△ADC%=(ADC后-ADC前)/ADC前×100%,有效组ADC值变化率增加比较明显,△ADC(%)=(28.23±3.97)%,而无效组ADC值变化率有轻度的增加或部分病灶△ADC值减少,△ADC(%)=(2.5±2.27)%。运用独立样本t检验统计学方法,所得治疗1周期后在有效组与无效组之间ADC值变化率存在统计学差异(t=5.537,p=0.029),即治疗后1周期有效组ADC值变化率高于无效组。然后运用受试者工作特征(ROC)曲线评估治疗1周期ADC值变化率诊断效能,以治疗1周期ADC值升高以12.9%为阈值时,检测肺癌脑转移治疗敏感性为81,8%,特异性为85.7%,ROC曲线下面积(AUC)为0.898,95%的可信区间0.805～0.992,提示有较高的诊断效能,具有较高的可信度。结论:1.磁共振扩散加权成像技术(DWI-MRI)可作为一种早期、无创、可重复的功能学成像方法,能够反映肿瘤治疗早期的微观病理改变,可以早期预测肺癌脑转移瘤放化疗联合中药治疗的疗效。2.肺癌脑转移瘤治疗前1周ADC值的大小,暂不能作为预测放化疗联合中药治疗疗效的一个指标。3.肺癌脑转移瘤在放化疗联合中药治疗1周期后,ADC值变化率预测治疗疗效具有较高的诊断效能,以治疗1周期ADC值变化率升高12.9%为阈值时,预测其治疗有效的敏感性为81.8%,特异性为85.7%。
[Abstract]:Objective: through the observation of brain metastasis from lung cancer in chemotherapy combined with traditional Chinese medicine before treatment, after the change of ADC value, ADC analysis of early lesions treatment the effective group and the ineffective group value changes of diffusion weighted magnetic resonance imaging (DWI) as an early, noninvasive, repeatable functional imaging method based on the treatment of early ADC value detection, to evaluate the application value of early brain metastasis from lung cancer on the efficacy of chemotherapy combined with traditional Chinese medicine treatment. Methods: We collected 30 cases of pathological or clinical and imaging diagnosis of brain metastasis from lung cancer patients, respectively in patients with combined radiotherapy and chemotherapy in the treatment of 1 weeks before, 1 cycles of treatment, after 2 cycles of chemotherapy T1WI scan, T2WI scan, enhanced T1WI and MRI diffusion weighted magnetic resonance imaging (DWI) examination, through conventional and enhanced T1WI MRI images were chosen to measure the largest diameter and maximum level, compared to before the treatment and treatment after the 2 cycle of mass volume Change in accordance with the evaluation criteria in solid tumors (RECIST), which can be divided into the effective group and the ineffective group. Then DWI image (b=01000s/mm2) sent to the PHILPS workstation to generate ADC map, measure the ADC value of treatment before the effective group and the ineffective group ADC values were compared using statistical methods, independent samples t test. Understand the ADC value of lesions before treatment had the function to predict curative effect for brain metastasis from lung cancer treatment. The formula to calculate the effective group and ineffective group ADC change for 1 cycles: the rate of ADC%= (ADC -ADC ago) before /ADC * 100% to 1 weeks after the treatment period, the effective group and the ineffective group in contrast with the independent ADC% sample t test analysis, understand whether it has statistical significance. In addition, according to the ADC% of different groups of data, using the receiver operating characteristic (ROC) curve to evaluate the diagnostic efficacy of 1 treatment period DELTA ADC%, Delta ADC% get the best threshold. The number of all According to the analysis by SPSS20.0 software. Results: 30 cases of patients with a total of 43 lung cancer patients with brain metastases before treatment, lesions of maximum diameter (2.78 + 0.15) cm, after 1 cycles of chemotherapy were the largest diameter (2.69 + 0.14) cm lesions before treatment and after 1 cycles of treatment, the maximum diameter of comparison, the difference was not statistically significant (t=1.725, P=0.092), suggesting that lung cancer metastases were no significant difference in the volume change of early comprehensive treatment. After treatment after 2 cycles, the maximum diameter of lesions (2.24 + 0.13) cm, and the maximum diameter of lesions before treatment (2.78 + 0.15) cm comparison, the difference was statistically significant (t=1.420, P=0.000), 22 cases (effective group), 21 cases were invalid (invalid group), suggest that the lesions after treatment after 2 cycles. There were significant differences in tumor volume changes before treatment, the average ADC value of the group within a week of lung cancer with brain metastasis (0.97 + 0.05) * 10-3mm2 /s, and the invalid group average ADC value was (1.17 + 0.06 * 10-3mm) 2/s, there was no significant difference between the effective group and ineffective group (t=2.42, p=0.083), indicating that the treatment before the maximum ADC can not predict the response to treatment. Effective treatment before the 1 cycle the average value of ADC (0.97 + 0.05) * 10-3mm2/s, after 1 cycles of treatment. The average ADC value (1.21 + 0.04) * 10-10-3mm2/s, was statistically significant the difference between the two (t=-8.76, p=0.000). It is effective in treatment group after 1 cycles of ADC value was significantly higher. And the ineffective treatment group before treatment, 1 cycle average ADC value (1.17 + 0.07) * 10-3mm2/s, the average ADC value after 1 cycles after treatment (1.20 + 0.08) * 10-3mm2/ s, there were no significant difference between them (t=-0.98, p=0.33), that is invalid in treatment group after 1 cycles of ADC lesions may increase or decrease. The calculated according to the formula ADC%= (ADC -ADC ago) before /ADC * 100%, effective group variation rate of ADC increased obviously, ADC (%) = (28.23 + 3.97)%, and the invalid group ADC value the rate of change of a slight increase Or part of the lesions Delta ADC values decrease, ADC (%) = (2.5 + 2.27)%. Using independent sample t test statistical method, obtained after 1 cycles of chemotherapy in the effective group and ineffective group there was significant difference in the rate of change of the value of ADC (t=5.537, p=0.029), the value of 1 cycle change is higher than the effective group ADC invalid group after treatment. Then using the receiver operating characteristic (ROC) curve to evaluate the treatment of 1 cycle variation rate of ADC diagnostic efficiency in the treatment of 1 cycles of ADC increased to 12.9% as the threshold, the detection of brain metastases of lung cancer treatment sensitivity 81,8%, specificity of 85.7%, area under the ROC curve (AUC) for the confidence interval 0.898,95% 0.805 ~ 0.992, suggesting a higher diagnostic efficiency, has a higher reliability. Conclusion: 1. diffusion weighted magnetic resonance imaging (DWI-MRI) can be used as an early, noninvasive, repeatable functional imaging method, which can reflect the microscopic pathological change early tumor treatment Change can be predicted in 1 weeks before treatment ADC value of chemotherapy combined with traditional Chinese medicine treatment of lung cancer with brain metastasis effect.2. brain metastasis of lung cancer early, can not be used to predict the effect of chemotherapy combined with traditional Chinese medicine treatment on a.3. index of brain metastasis from lung cancer in chemotherapy combined with traditional Chinese medicine in the treatment of 1 weeks after the ADC value of diagnostic efficiency the prediction has high curative effect in the treatment of rate change, with 1 cycles of treatment ADC value change rate increased 12.9% as the threshold, to predict the effective therapeutic sensitivity was 81.8%, specificity was 85.7%.

【学位授予单位】：北京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R445.2;R734.2

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