动态增强磁共振联合扩散加权成像在宫颈癌新辅助化疗疗效评估中的价值

发布时间：2018-05-05 17:08

  本文选题：宫颈肿瘤 + 新辅助化疗　； 参考：《昆明医科大学》2017年硕士论文

【摘要】：目的:探讨动态对比增强磁共振(dynamic contrast-enhanced MRI,DCE-MRI)定量参数(Ktrans,Kep,Ve,Vp)联合扩散加权成像(diffusion weighted imaging,DWI)的表观扩散系数(apparent diffusion coefficient,ADC)对宫颈癌新辅助化疗(neoadjuvant chemotherapy,NACT)疗效评估的价值。材料与方法:收集38例经病理证实的据国际妇产科联盟(International Federation of GynecologyandObstetrics,FIGO)分期均为巨块型 IB2-IIA 期(长径(?)4cm)和IIB期宫颈癌患者资料,所有患者均在治疗前、NACT一个疗程结束一个月后分别行常规磁共振扫描、DCE-MRI及DWI扫描。治疗后根据实体肿瘤疗效评价标准(Response Evaluation Criteria in Solid Tumors,RECIST)将治疗疗效分为两组:反应组和非反应组,其中反应组(significant reaction group,sCR)包含CR完全缓解(Complete Response, CR)和 PR 部分缓解(Partial Response, PR),非反应组(non-significant reaction group, non-sCR)包含 SD 疾病稳定(Stable Disease, SD)和PD疾病进展(Progressive Disease, PD)。测量并比较各组治疗前后DCE-MRI定量参数(Krans_,Kep,Ve,Vp)和ADC值(平均ADC值、最小ADC值)及相应参数变化值(△治疗=治疗后参数—治疗前参数)有无差异,采用ROC (receiver operating characteristic curve)分析分析各参数对治疗反应性评估的效能,并获得sCR组与non-sCR组的疗效预测及评估的临界点。结果:38例患者平均年龄为44.79±8.17岁,其中ⅠB2期患者14例;ⅡA期1例;ⅡB期23例。治疗后,sCR组患者22例,non-sCR组16例。治疗前sCR组的Ktrans,Kep,Ve,Vp、平均 ADC 及最小 ADC 均值分别为:0.875±0.329min-1、1.612+0.733min-1、0.661 ±0.184min-1、0.283±0.208 min-1、971.612±140.209mm2/s、640.943 ±200.697mm2/s; non-sCR 为:0.549±0.314min-1、1.557±0.680min-1、0.791± 0.117 min-1、0.205 ± 0.123 min-1、918.779 ± 140.991 mm2/s、548.619 ±213.220mm2/s; sCRKtrans高于non-sCR组,Ve低于non-sCR组,差异有统计学意义(z=-3.134, p0. 05; z=-2.129, p0. 05)。治疗后,sCR 组的 Ktrans, Kep,Ve,Vp平均 ADC 及最小 ADC 均值分别为:0.553±0.347min-1、1.523±0.849min-1、0.746±0.221 min-1、0.201 ±0.194min-1、1048.238±139.899mm2/s、710.916± 155.863 mm2/s;non-sCR 组为:0.942±0.508 min-1、1.960±0.990 min-1、0.758±0.177 min-1、0.203±0.151min-1、947.050±153.514mm2/s、545.458±163.015mm2/s; sCR组Ktrans及△Ktrans_ (△Ktrans=-0.322±0.261min-1)低于 non-sCR 组,平均 ADC 值、最小ADC值高于non-sCR组,差异有统计学意义(z=-2.602,p0. 05; t=-6.074,p0. 05 ; z=-2.099, p0.05;t=3.170,p0.05)。其余各参数无统计学差异。治疗前Ktrabs、治疗前Ktrans联合治疗后平均ADC值用于预测化疗疗效效果的曲线下面积(AUC)分别为 0.801 (p0. 05)、0.878 (p0. 05),治疗前 Ktrans的诊断阈值为0.7020 (敏感度为77.3%,特异度为81.22%)。结论:1、DCE-MRI定量参数及DWI的ADC值能够反映宫颈癌NACT前后的血流动力学及水分子扩散运动变化情况,是一种能从微观上评估肿瘤疗效的新途径和方法,有望成为早期评价宫颈癌治疗疗效的影像学方法。2、定量DCE-MRI联合DWI并不比两种技术单独应用能显著提高NACT疗效的诊断效能。
[Abstract]:Objective: to evaluate the value of dynamic contrast-enhanced MRII-DCE-MRI quantitative parameters and diffusion weighted diffusion imaging (DWI) in evaluating the efficacy of neoadjuvant chemotherapy in neoadjuvant chemotherapy of cervical cancer (neoadjuvant NACTs) by dynamic contrast enhanced Mr imaging (DCE-MRI) and diffusion weighted imaging (DWI). Materials and methods: data of 38 pathologically confirmed cervical cancer patients with large IB2-IIA stage (long diameter 4 cm) and IIB stage according to International Federation of Gynecology and Obstetrics Figo were collected. All patients underwent conventional magnetic resonance imaging (DCE-MRI) and DWI scan one month after the end of a course of treatment. After treatment, the patients were divided into two groups according to response Evaluation Criteria in Solid tumor RECIST: reactive group and non-reactive group. The response group included complete CR complete response (CRs) and PR partial response (PRP), non-significant reaction group (non-sCRs) including SD stable disease release (SDS) and PD progressive disease progression (PDS), which included CR complete response (CR) and PR partial response (PRP), non-significant reaction group (non-sCRs), including SD (SD) and PD progressive disease progression (PDS), which included complete response (CR), partial response (PR), non-significant reaction group (non-sCRs), and progressive disease progression (PD). The quantitative parameters of DCE-MRI were measured and compared before and after treatment. There were no differences in ADC, ADC (mean ADC value, minimum ADC value) and the corresponding parameters before and after treatment (treatment = post-treatment parameters-pre-treatment parameters). ROC receiver operating characteristic curve was used to analyze the efficacy of each parameter in evaluating the response to treatment, and the critical points for predicting and evaluating the efficacy of sCR group and non-sCR group were obtained. Results the average age of 38 cases was 44.79 卤8.17 years old, including 14 cases of stage 鈪，

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