磁共振动态增强成像在直肠癌新辅助放化疗疗效评估中的应用价值

发布时间：2018-04-19 18:15

本文选题：直肠癌 + 磁共振成像　；参考：《广州医科大学》2017年硕士论文

【摘要】：目的:探讨直肠癌磁共振动态增强成像(dynamic-contrast enhanced magnetic resonance imaging,DCE-MRI)相关参数的变化,阐明直肠癌微血管生成与DCE-MRI血流动力学之间的关系。探讨DCE-MRI在直肠癌术前新辅助放化疗监测中的意义,为直肠癌治疗方案的选择、术前评估、新辅助治疗疗效评估提供参考依据。临床资料和方法:选取经病理证实的直肠癌患者31例,其中分入A组的20例直接行手术治疗,分入B组的11例术前需行新辅助放化疗。A组于手术前行常规盆腔MRI及矢状位动态增强扫描1次,B组分别于新辅助放化疗前及放化疗后手术前各行常规盆腔MRI及矢状位动态增强扫描1次。选择直肠癌灶、正常直肠肠壁、盆壁肌肉作为感兴趣区(region of interest,ROI)绘制时间-信号曲线(time-intensity curve,TIC),得出曲线参数,包括相对信号强化率(relative enhancement,RE)、最大相对信号强化率(maximum relative enhancement,MRE)、最大信号强化率(maximum enhancement,ME)及信号达峰时间(time to peak,TTP)。所有病例术后对癌灶标本进行常规HE染色和用单克隆鼠抗人CD34抗体行血管标记、染色,测定肿瘤组织内肿瘤微血管密度(microvessel density,MVD)。将癌灶、癌灶邻近正常直肠肠壁、盆壁肌肉组织的TIC参数进行对比分析,然后将A组和B组的MVD值与肿瘤各TIC参数进行对比分析,最后将B组行新辅助放化疗前后的磁共振动态增强影像学表现及TIC参数进行统计分析。结果:1、癌灶、正常直肠肠壁及盆壁肌肉的RE值分别为(135.33±41.37)、(92.84±32.10)、(27.76±17.37),MRE值分别为(137.69±41.44)、(103.82±42.14)、(22.81±28.89),RE、MRE值两两比较差异均有统计学意义(p0.05);癌灶、正常直肠肠壁及盆壁肌肉的ME值分别为(1037.16±326.24)、(897.65±387.01)、(160.95±160.34),肿瘤与正常直肠黏膜、肌肉组织ME值差异均有统计学意义(p0.05);肿瘤TTP值分别明显低于正常直肠黏膜与肌肉组织,差异有统计学意义(p0.05),正常直肠黏膜与盆壁肌肉TTP未见显著性差异。2、31例直肠癌ME值与MVD呈正相关(p0.05),相关系数γ=0.717,RE、MRE、TTP与MVD均无明显相关性(p0.05)。A组与未治疗前的B组各TIC参数均未见显著性差异(p0.05)。A组与行放化疗后的B组对比,A组ME值为(1017.67±297.82),明显高于放化疗后B组的(708.30±97.44),差异有统计学意义(p0.05),两组间RE、MRE、TTP值差异无统计学意义(p0.05)。A组MVD值为(16.10±8.77)条/200HP,明显高于B组的(7.20±4.60)条/200HP,差异有显著性(p0.05)。3、B组肿瘤放化疗后9例见残留灶,但肿瘤明显缩小;2例病灶仅见直肠粘膜增厚,未见明显肿块影。B组放化疗前ME值为(1076.15±412.42),明显高于放化疗后的(708.30±97.44),差异有统计学意义(p0.05);余RE、MRE、TTP值在放化疗前后未见显著性差异。结论:1、DCE-MRI的TIC参数ME、RE、MRE、TTP值均显著高于较直肠粘膜、肌肉组织,能反映直肠癌高灌注、富血管等特点,对直肠癌的诊断有一定的参考价值。2、直肠癌DCE-MRI的ME值与其病理MVD值呈正相关性,ME值可作为评价直肠癌微循环灌注的重要参数。3、ME值可较客观地反映直肠癌术前新辅助放化疗过程中肿瘤内部微血管的变化,对直肠癌放化疗疗效的评价有一定参考价值。
[Abstract]:Objective: To investigate the changes in the parameters of dynamic-contrast enhanced magnetic resonance imaging (DCE-MRI) in rectal cancer and to elucidate the relationship between the angiogenesis of rectal cancer and the hemodynamics of DCE-MRI, and to explore the significance of DCE-MRI in the monitoring of neoadjuvant radiochemotherapy before operation for rectal cancer and for the treatment of rectal cancer. Selection, preoperative evaluation and new adjuvant treatment evaluation provided reference basis. Clinical data and methods: 31 cases of rectal cancer confirmed by pathology were selected, of which 20 cases were divided into group A and 20 cases were operated directly, and 11 cases of group B were divided into group.A before operation, and before operation, the routine pelvic MRI and sagittal dynamic enhanced scan was performed before operation, B MRI and sagittal dynamic enhanced scan were performed 1 times before and before neoadjuvant radiotherapy and chemotherapy. Rectal carcinoma, normal rectal wall, and pelvic wall muscles were used as region of interest (ROI) to draw time signal curve (time-intensity curve, TIC), and the curve parameters, including relative signal strength, were obtained. Relative enhancement (RE), the maximum relative signal enhancement rate (maximum relative enhancement, MRE), the maximum signal enhancement rate (maximum enhancement, ME) and signal peak time (time to). The tumor microvascular density (microvessel density, MVD) in the tumor tissue was compared with the TIC parameters of the muscle tissue of the pelvic wall adjacent to the normal rectal wall. Then the MVD values of the A and B groups were compared with the TIC parameters of the tumor. Finally, the dynamic enhanced imaging performance of the magnetic resonance imaging (MRI) before and after the new adjuvant radiochemotherapy was performed in the B group. The results were as follows: 1: 1, the RE values of the carcinoma, the normal rectal wall and the pelvic wall were (135.33 + 41.37), (92.84 + 32.10), (27.76 + 17.37), the MRE values were (137.69 + 41.44), (103.82 + 42.14), (22.81 + 28.89), RE, MRE values were statistically significant (P0.05), cancer, normal rectal wall and pelvic wall muscle. The ME value of meat was (1037.16 + 326.24), (897.65 + 387.01) and (160.95 + 160.34). The difference of ME value between the tumor and normal rectal mucosa and muscle tissue was statistically significant (P0.05), and the TTP value of the tumor was significantly lower than that of the normal rectal mucosa and muscle tissue (P0.05). There was no significant difference between the normal rectal mucosa and the TTP of the pelvic muscles. There was no significant correlation between the ME value of rectal cancer in.2,31 and MVD (P0.05). There was no significant correlation between the correlation coefficient gamma =0.717, RE, MRE, TTP and MVD (P0.05).A group and the B group before and before the treatment. The value of the group was (1017.67 + 297.82), which was significantly higher than that of the group after radiotherapy and chemotherapy (708.30 + 97.) 44) the difference was statistically significant (P0.05). There was no significant difference in the value of RE, MRE, and TTP between groups (P0.05).A group MVD value (16.10 + 8.77) /200HP, obviously higher than (7.20 + 4.60) /200HP in group B (7.20 + 4.60) /200HP, the difference was significant (P0.05).3, 9 cases of tumor after radiotherapy and chemotherapy, but the tumor was obviously narrowed, and the lesions of the rectum were only thickened in the 2 case. The ME value of.B group was (1076.15 + 412.42) before and after chemotherapy, which was significantly higher than that after radiotherapy and chemotherapy (708.30 + 97.44). The difference was statistically significant (P0.05); the value of residual RE, MRE and TTP had no significant difference before and after radiotherapy and chemotherapy. Conclusion: 1, DCE-MRI TIC parameters ME, RE, MRE, significantly higher than the rectal mucosa, muscle tissue, reflecting higher rectal cancer. The characteristics of perfusion, rich blood vessel and so on have certain reference value for the diagnosis of rectal cancer. The ME value of rectal cancer DCE-MRI is positively correlated with the MVD value of the pathology. ME value can be used as an important parameter to evaluate the microcirculation perfusion of rectal cancer. The ME value can objectively reflect the changes of the microvessels within the neoplasm in the neoadjuvant radiotherapy and chemotherapy of rectal cancer before operation. The value of ME can be objectively reflected. The evaluation of the efficacy of radiotherapy and chemotherapy for colorectal cancer is of some reference value.

【学位授予单位】：广州医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R735.37;R445.2

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