MR功能成像在局部进展期胃癌新辅助治疗疗效评价的应用

发布时间：2020-08-01 20:54

【摘要】：目的:探究磁共振成像功能对局部进展期胃癌新辅助放化疗后疗效评价的临床应用价值。方法:前瞻性收集自2017年8月至2018年12月就诊于我院的局部进展期胃癌病例。于放化疗前、后分别进行常规T1WI、T2WI、DWI及DCE-MRI序列扫描。测量肿瘤治疗前后最厚径D_(before)及D_(after),并计算其差值ΔD。参照RECIST1.1标准行胃癌放化疗疗效评价。通过西门子(MAGNETOM skyra 3.0T)后处理工作软件Tissues 4D得出胃癌定量参数Ktans、Kep及ve并计算其变化值ΔKtans、ΔKep及ΔVe;ADC图上测量肿瘤的ADC值,计算治疗前后变化值ΔADC。术后TRG分为0,1,2,3,级。定义TRG(0,1,2)级为有效组,TRG3级为无效组。应用Spearson检验分析病灶化疗前后各参数变化值与肿瘤退缩分级的相关性;应用独立样本t检验或Mann-Whitney U检验分析两组间治疗前后ΔKtans,ΔKep,ΔVe及ΔADC值的差异性;再制作受试者工作特征ROC曲线,进一步分析最佳诊断效能值。比较两组间基线各参数是否存在统计学差异。P0.05认为有统计学差异。结果:参照RECIST标准判断胃癌NACR疗效的准确率为64%(16/25),灵敏度为53.3%(8/15),特异度为80%(8/10),阳性预测值为80%(8/10),阴性预测值为53.3%(8/15)。ΔKtrans、ΔKep与肿瘤退缩分级之间呈负相关(rho=-0.554,P=0.009;rho=-599,P=0.004)。ΔADC与TRG之间存在正相关性(rho=0.603,P=0.005)。有效组治疗后Ktrans、ADC的变化值ΔKtrans、ΔADC大于无效组,差异有统计学意义(P0.05)。应用ROC曲线,AUC为0.754,当ΔKtrans大于0.0075min~(-1)时,预测胃癌NACR有效的诊断准确率为80%,敏感性为92.9%,特异性为55.6%。对ΔADC做ROC曲线,AUC为0.857,当ΔADC绝对差值大于0.406×10~(-3)mm~2/s时,预测胃癌NACR有效的准确率为76%,敏感性为100%,特异性为71.4%。结论:磁共振功能成像DCE-MRI的治疗前后Ktrans变化值ΔKtrans及DWI成像的ADC变化值ΔADC对于进展期胃癌新辅助放化疗后疗效评价治疗反应有一定临床应用价值。
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2019
【分类号】：R735.2;R445.2
【图文】：

厚径,胃癌,测量方法,病灶

图 1 胃癌病灶最厚径测量方法Fig.1 Method for measuring the thickest diameter of gastric cancer lesionFig a shows the venous phase before NACR to make a perpendicular tostomach wall, and b is the thickest diameter after NACR.

功能参数,患者

图 2 TRG 为 3 级时患者的形态学测量与功能参数测量的比较Fig.2 Comparison of morphometric and functional parameter measurempatients with TRG 3. 60-year-old male, cardia cancer, Figure ab is thepre-NACR image of gastric cancer, c,d is the post-treatment image, e ispostoperative pathological section: a, c shows the lesion thickest diametbefore and after treatment reduced by 52.6%, Ktrans change value It wamin-1and the postoperative TRG was grade 3.

患者,功能参数,功能

图 3 TRG 为 0 级时患者的形态学测量与功能参Fig.3 Comparison of morphometric and functional paof patients with TRG of 0. 61-year-old male, cardia cathe value of NACR pre-cancerous lesions in gastric cavalue of NACR after gastric cancer: a, d is the most thmeasurement of cancer, the rate of change is 29.8%, bshows the quantitative parameter value of DCE-MRI.value is 0.082min-1. The c and e maps measure the ADlesion. The change value after treatment is 0.128×10-3is the gross pathological specimen of the postoperativTRG level 0.

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