DCE-MRI定量参数评价放疗前后鼻咽癌肿瘤血管变化及其对预后评估的价值

发布时间：2018-07-03 02:19

本文选题：鼻咽癌 + 放射治疗　；参考：《南方医科大学学报》2015年07期

【摘要】：目的纵向研究鼻咽癌放疗前后的DCE-MRI各种定量参数的变化及其对预后评估的价值。方法 24例经病理证实为低分化鳞状上皮细胞癌的鼻咽癌患者分别于放疗前1~2 d、放疗中(放射剂量为50 Gy)、放疗结束时(放射剂量为70 Gy)进行常规MRI和DCE-MRI扫描。以两腔室模型为基础,计算出定量血流动力学参数(Ktrans、kep、Ve)。比较放疗前、中及放疗结束时各参数的变化;分别探讨放疗中肿瘤消退率(RS0-50)与放疗前和放疗中各参数的相关性;并比较不同预后患者放疗结束时各参数的差别。结果放射治疗后肿瘤组织的Ktrans值呈下降趋势,放疗结束时肿瘤组织的Ktrans值与放疗前的差别有统计学意义,放疗中肿瘤组织的Ktrans值虽然下降,但与放疗前的差别无统计学意义。放射治疗后kep值下降,Ve值出现不同程度增高。放疗中肿瘤消退率与放疗前肿瘤组织的Ktrans值呈正相关(P值为0.005),与放疗中肿瘤组织的Ktrans值呈负相关(P值为0.001)。随访3年,5例患者死亡,3例出现远处转移;死亡、转移病例与其他患者放疗结束后的Ktrans值、kep值、Ve值的差异均无统计学意义。结论鼻咽癌放疗过程中DCE-MRI各定量血流动力学参数变化明显。放疗前和放疗中肿瘤组织Ktrans值可作为鼻咽癌放疗早期疗效评估指标,为鼻咽癌个体化治疗和治疗方案修正提供依据。鼻咽癌放疗远期疗效与Ktrans值的关系需进一步深入研究。
[Abstract]:Objective to study the changes of DCE-MRI quantitative parameters before and after radiotherapy in nasopharyngeal carcinoma (NPC) and its prognostic value. Methods Twenty-four patients with poorly differentiated squamous cell carcinoma of nasopharyngeal carcinoma (NPC) were examined with conventional MRI and DCE-MRI at the end of radiotherapy (radiation dose: 50Gy) and radiotherapy (50Gy) 1 day before radiotherapy. Based on the two-chamber model, the quantitative hemodynamic parameters (Ktranskepepepve) were calculated. The changes of parameters before, during and after radiotherapy were compared; the correlation between tumor regression rate (RS0-50) and parameters before and after radiotherapy was investigated, and the difference of parameters in patients with different prognosis at the end of radiotherapy was compared. Results the Ktrans value of tumor tissue showed a downward trend after radiotherapy. The Ktrans value of tumor tissue at the end of radiotherapy was significantly different from that before radiotherapy. Although the Ktrans value of tumor tissue decreased during radiotherapy, there was no significant difference between the Ktrans value of tumor tissue and that before radiotherapy. After radiotherapy, the value of kep decreased and the value of ve increased in varying degrees. The regression rate of tumor was positively correlated with Ktrans value of tumor tissue before radiotherapy (P = 0.005) and negatively correlated with Ktrans value of tumor tissue during radiotherapy (P = 0.001). There was no significant difference in the Ktrans value and the value of kep and ve between the dead and the other patients after radiotherapy after 3 years follow up in 5 patients with death and 3 patients with distant metastasis. 3 cases were followed up for 3 years, and there was no significant difference between the death cases and the other patients after radiotherapy. Conclusion the quantitative hemodynamic parameters of nasopharyngeal carcinoma were significantly changed during radiotherapy. The Ktrans value of tumor tissue before and during radiotherapy can be used as an index to evaluate the early curative effect of radiotherapy for nasopharyngeal carcinoma and provide basis for individualized treatment of nasopharyngeal carcinoma and revision of treatment scheme. The relationship between long-term effect of radiotherapy and Ktrans value in nasopharyngeal carcinoma needs further study.
【作者单位】：中南大学湘雅医院放射科;中南大学肿瘤研究所教育部重点实验室;中南大学湘雅医院肿瘤科;中南大学湘雅医院分子医学中心;
【基金】：国家“863”计划项目(2009AA02Z403) 国家自然科学基金(81000596) 中国博士后科学基金(2013M531815)~~
【分类号】：R445.2;R739.63

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