磁共振扩散加权成像及功能扩散图在评价局部进展期直肠癌术前放化疗疗效的价值

发布时间：2018-04-10 09:06

  本文选题：直肠癌　切入点：表观扩散系数　出处：《广州医科大学》2017年硕士论文

【摘要】：目的:探讨磁共振扩散加权成像表观扩散系数及功能扩散图对局部进展期直肠癌术前放化疗早期监测的可行性及应用价值,为临床个体化治疗方案的制定提供可靠的影像学依据。临床资料和方法:收集2015年3月至2016年12月于我院诊治的经病理证实的局部进展期直肠癌患者32例作为研究对象,所有患者行术前同步放化疗并分别于放化疗前(A节点)、放化疗第l周后(B节点)、放化疗第2周后(C节点)、放化疗结束后(D节点)4个监测时间点行常规MRI及DWI检查,生成对应的ADC图及功能扩散图,分别测量肿瘤的浸润深度及ADC值,计算不同监测时间点ADC值的变化情况(包括变化值△ADC及变化率ADC%)以及功能扩散图中红色体素占比的变化值。根据Dworak’s肿瘤消退分级(tumor regression grade,TRG)标准将患者分为非敏感组(TRG0-2级)和敏感组(TRG3-4级)。采用两独立样本t检验、Wilcoxon秩和检验、单因素方差分析、Kruskal-Wallis检验及ROC曲线对数据进行统计学分析。结果:1.32例直肠癌患者的肿瘤浸润深度在不同时间节点之间存在显著的统计学差异(P0.05),肿瘤的浸润深度在治疗过程中逐渐降低,主要集中在治疗中后期;肿瘤的ADC值在不同时间节点之间亦存在显著的统计学差异(P0.05),ADC值在治疗过程中呈逐渐升高趋势,在治疗早期即显示出明显差异。2.32例患者中敏感组或非敏感组分别为20例和12例。敏感组和非敏感组不同时间节点的肿瘤ADC值比较均具有显著统计学差异(P0.05),两组的ADC值都随治疗时间逐渐上升。在A、B、C治疗时间节点中敏感组的肿瘤ADC值与非敏感组二者比较均无统计学差异(P0.05);而D节点敏感组肿瘤的ADC值大于非敏感组的,且差异具有统计学意义(P0.05)。敏感组的△ADC1(放化疗1周后与放化疗前ADC值的差值)、△ADC3(放化疗结束后与放化疗第2周后ADC值的差值)大于非敏感组对应的ADC1、ADC3,且具有统计学差异(P0.05)。敏感组的△ADC2(放化疗第2周与第1周ADC值的差值)大于非敏感组的△ADC2,但二者无统计学差异(P0.05)。3、以治疗后第1周肿瘤ADC值的升高值、变化率以及fDM红色体素占比的变化值作为预测肿瘤对放化疗敏感性的指标,采用ROC曲线分析结果如下:ADC值的升高值预测肿瘤对放化疗反应为敏感组的阈值为0.128×10-3 mm2/s,敏感性为70.0%,特异性为75.0%,曲线下面积为0.754(95%可信区间0.570~0.888);ADC变化率预测肿瘤对放化疗反应为敏感组的阈值为13.46%,敏感性为75.0%,特异性为66.7%,曲线下面积为0.733(95%可信区间0.548~0.873);红色体素占比变化值预测肿瘤对放化疗反应为敏感组的阈值为18.78%,敏感性为85.0%,特异性为91.7%,曲线下面积为0.875(95%可信区间0.710~0.965)。上述三个指标的ROC曲线比较结果显示fDM红色体素占比的变化值的曲线下面积最大,但三者ROC的曲线下面积两两比较均无统计学意义(P0.05)。结论:1、ADC值反映肿瘤内部微环境的变化,能早期、定量地评估直肠癌术前放化疗的治疗效果,较通过形态学改变来评估疗效的方法有明显优势。2、在直肠癌术前放化疗的过程中,ADC值及其变化情况一定程度反映了癌肿对放化疗的敏感程度,对治疗方案的调整具有指导意义。3、直肠癌放化疗第1周ADC值的变化值及变化率、fDM红色体素占比变化值在早期判断癌肿对放化疗敏感与否具有较高的诊断效能,而fDM红色体素占比的变化值的诊断价值最高。
[Abstract]:Objective: To investigate the magnetic resonance diffusion-weighted imaging apparent feasibility and application of chemotherapy and early detection of locally advanced rectal cancer preoperative diffusion coefficient and diffusion graph function value, making treatment for clinical provide reliable imaging evidence. The clinical data and methods: from March 2015 to December 2016 in our hospital by pathology confirmed locally advanced rectal cancer in 32 cases as the object of study, all patients underwent preoperative chemoradiotherapy and chemotherapy respectively before chemotherapy (A node), l weeks (B node), after second weeks of chemotherapy (C node), after the end of radiotherapy and chemotherapy (D node) 4 monitoring at the time of routine MRI and DWI examination, ADC diagram and function to generate the corresponding diffusion map, tumor invasion depth were measured and calculated ADC value changes of different time point monitoring ADC value (including the change value of delta ADC and ADC% and the rate of change) The function of diffusion map red voxel accounted for the change value. According to the Dworak 's (tumor regression grade TRG, TRG standard) were divided into non sensitive group (TRG0-2) and sensitive group (TRG3-4). By using two independent samples t test, Wilcoxon test, analysis of variance in Dan Yin. Kruskal-Wallis test and ROC curve of the data were analyzed. Results: 1.32 cases of rectal cancer patients with tumor invasion depth. There was a statistically significant difference between different time points (P0.05), depth of tumor invasion decreased gradually in the course of treatment, mainly concentrated in the late treatment; there is significant difference between different time points tumor ADC value (P0.05), the ADC value in the course of treatment was gradually increasing, in the treatment of early.2.32 patients showed significant differences in the sensitive group and non sensitive group were 20 cases and 12 cases of sensitivity. 鎰熺粍鍜岄潪鏁忔劅缁勪笉鍚屾椂闂磋妭鐐圭殑鑲跨槫ADC鍊兼瘮杈冨潎鍏锋湁鏄捐憲缁熻�″�﹀樊寮，

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