超声造影定量分析对结直肠癌肝转移化疗和靶向治疗疗效的早期预测和评估
发布时间：2019-06-25 08:30
【摘要】：目的： 探讨超声造影（CEUS）定量分析在结直肠癌肝转移化疗和靶向治疗（贝伐单抗联合化疗）疗效早期预测和评估中的应用价值，为临床早期判断疗效和预后或制定治疗方案提供依据。 方法： （1）设定入组标准和排除标准，选取年龄18-75岁之间经病理学和/或细胞学证实的预进行化疗和贝伐单抗联合化疗的结直肠癌肝转移患者，有超声影像和CT影像可测量的病灶；无重要器官的功能障碍，，血常规、肝、肾功能及心脏功能基本正常，预计生存期3个月以上，能理解本研究的并签署知情同意书者。 （2）对符合标准的61例结直肠癌肝转移患者随机行化疗和贝伐单抗联合化疗（化疗组为26例，贝伐单抗联合化疗组为35例），在治疗前及给药后第3、7、14、42、60天分别行常规超声及CEUS检查，并于治疗后第一个月末和第二个月末行增强CT检查。且依据治疗后增强CT检查的两个月评判结果，将61例结直肠癌肝转移患者分为治疗有效组和治疗无效组。 （3）使用SonoTumor定量分析软件对时间强度曲线的六个功能参数进行计算。选取的时间强度曲线的六个功能参数，分别为上升时间（RT）、平均渡越时间（mTT）、峰值强度（PE）、流入相曲线下面积（WiAUC）、流入相斜率（WiR）、流入相灌注指数（WiPI）。其中，上升时间（RT）为峰值强度从10%上升到90%的所需时间。平均渡越时间（mTT）为从强度开始上升到峰值强度下降一半所需时间。峰值强度（PE）为达到峰值时的信号强度，与血流最大流量相关。流入相曲线下面积（WiAUC）为曲线上升支下的面积，与流入相的血流灌注量相关。流入相斜率（WiR）与血流最大流量及灌注时间相关。流入指数（WIPI）为流入相曲线下面积除以流入时间。 （4）采用改良实体瘤疗效评价标准（mRECIST标准），分别针对治疗有效组和治疗无效组进行结直肠癌肝转移化疗和靶向治疗疗效评估，分析时间强度曲线六个定量参数与mRECIST标准的相关性。 结果： （1）化疗治疗有效组和治疗无效组，治疗前CEUS定量分析的上升时间(RT)、平均渡越时间(mTT)、流入相曲线下面积(WiAUC)、峰值强度(PE)、流入相比率(wiR)和流入相灌注指数(WiPI)差异无统计学意义(P0.05)。 （2）贝伐单抗联合化疗治疗有效组治疗前CEUS定量分析的上升时间(RT)差异有统计学意义(P0.05)，而平均渡越时间(mTT)、流入相曲线下面积(WiAUC)、峰值强度(PE)、流入相比率(wiR)和流入相灌注指数(WiPI)差异无统计学意义(P0.05)。贝伐单抗联合化疗治疗无效组治疗前CEUS定量分析的上升时间(RT)、平均渡越时间(mTT)、流入相曲线下面积(WiAUC)、峰值强度(PE)、流入相比率(wiR)和流入相灌注指数(WiPI)差异无统计学意义(P0.05)。 （3）化疗有效组与无效组相比较，CEUS定量分析参数中的上升时间(RT)在治疗后第3天较治疗前延长(P0.05)，而平均渡越时间(mTT)、流入相曲线下面积(WiAUC)、峰值强度(PE)、流入相比率(WiR)和流入相灌注指数(WiPI)在治疗后第3天差异无统计学意义(P0.05)。且CEUS定量分析各功能参数上升时间(RT)、平均渡越时间(mTT)、流入相曲线下面积(WiAUC)、峰值强度(PE)、流入相比率(wiR)和流入相灌注指数(WiPI)在治疗后第7、14、42、60天差异无统计学意义(P0.05)。 （4）贝伐单抗联合化疗有效组与无效组相比较，CEUS定量分析参数中的上升时间(RT)、平均渡越时间(mTT)在治疗后第3天较治疗前延长(P0.05)，而流入相曲线下面积(WiAUC)、峰值强度(PE)、流入相比率(WiR)和流入相灌注指数(WiPI)在治疗后第3天差异无统计学意义(P0.05)。且CEUS定量分析各功能参数上升时间(RT)、平均渡越时间(mTT)、流入相曲线下面积(WiAUC)、峰值强度(PE)、流入相比率(wiR)和流入相灌注指数(WiPI)在治疗后第7、14、42、60天差异无统计学意义(P0.05)。 结论： （1）超声造影定量分析时间强度曲线的六个功能参数（上升时间(RT)、平均渡越时间(mTT)、流入相曲线下面积(WiAUC)、峰值强度(PE)、流入相比率(wiR)和流入相灌注指数(WiPI)）是早期预测和评估结肠癌肝转移化疗和靶向治疗疗效的指标。其中，上升时间(RT)是早期预测和评估结肠癌肝转移化疗疗效的有效指标，上升时间(RT)、平均渡越时间(mTT)是早期预测和评估结肠癌肝转移靶向治疗疗效的有效指标。 （2）超声造影定量分析有望成为早期预测和评估结直肠癌肝转移化疗和靶向治疗疗效的影像学方法。
[Abstract]:Purpose: To evaluate the value of the quantitative analysis of CEUS in the early prediction and evaluation of the curative effect of liver transfer chemotherapy and targeted therapy (bevacizumab in combination with chemotherapy) in colorectal cancer, and to provide the basis for the early judgment of the curative effect and the prognosis or the formulation of the treatment plan. It was reported. Methods: (1) To set the criteria for inclusion and exclusion, and to select the patients with colorectal cancer who were pre-treated by pathology and/ or cytological confirmation between 18 and 75 years of age, with the combination of chemotherapy and bevacizumab, and the ultrasound and CT images may The measured lesions; the function of non-vital organs, blood routine, liver, kidney function and heart function are basically normal, the survival time is more than 3 months, and the study is understood and signed (2) The combination of chemotherapy and bevacizumab in 61 patients with colorectal cancer (26 patients in the chemotherapy group and 35 in the combination of the bevacizumab and the chemotherapy group) was performed in 61 patients with colorectal cancer according to the standard. Routine ultrasound was performed at the 3rd, 7th, 14th, 42nd and 60th day before and after treatment. and CEUS, and at the end of the first month and the end of the second month after the treatment In line-enhanced CT,61 patients with colorectal cancer were divided into treatment effective according to the two-month evaluation of the post-treatment enhanced CT. And treatment of the invalid group. (3)6.6.6.6.6.6.6.6.6.6.3)6.6.6.6.6.6.6. The function parameters are calculated. The six functional parameters of the selected time intensity curve are rise time (RT), mean transit time (mTT), peak intensity (PE), area under the inflow phase curve (WiAUC), inflow phase slope (WiR), inflow phase irrigation, Note Index (WPI), where the rise time (RT) is the peak intensity rising from 10% The required time to 90%. The average transit time (mTT) is rising from the strength to the peak the peak intensity (pe) is the signal strength when the peak is reached, The area under the inflow phase curve (WiAUC) is the area under the rising branch of the curve and is related to the inflow Related to the amount of blood flow in the phase. The inflow phase slope (WiR) and the blood flow are the largest Flow and irrigation time-related. The inflow index (WIPI) is the inflow phase curve The lower area divided by the inflow time; (4) the modified solid tumor effect evaluation standard (mRECIST standard) was adopted to evaluate the effect of the treatment of the liver metastasis and the targeted treatment of the colorectal cancer in the treatment effective group and the treatment ineffective group, and the six quantitative parameters of the time intensity curve and the mR were analyzed. ECI Results: (1) The effective and ineffective treatment group, the rise time (RT), mean transit time (mTT) of the pre-treatment CEUS quantitative analysis, the area under the inflow phase curve (mTT). WiAUC), peak intensity (PE), inflow rate (wiR), and inflow phase perfusion index (WiPI) There was no significant difference (P0.05). (2) The rise time (RT) of CEUS quantitative analysis before and after treatment with bevacizumab in combination with chemotherapy was of statistical significance (P0.05), while the mean transit time (mTT) was below the phase curve. product (WiAUC), peak intensity (PE), inflow rate (wiR), and inflow phase perfusion index (WiP I) The difference was not significant (P0.05). The rise time (RT), mean transit time (mTT) of the pre-treatment CEUS quantitative analysis with bevacizumab in combination with chemotherapy and the inflow phase curve product (WiAUC), peak intensity (PE), inflow rate (wiR), and inflow phase perfusion index (WiP (3) The rise time (RT) in the quantitative analysis of CEUS was prolonged before the treatment (P0.05), while the mean transit time (mTT) and the inflow phase curve were not statistically significant (P0.05). The lower area (WiAUC), peak intensity (PE), inflow rate (WiR), and inflow phase perfusion index (WiPI) were treated The 3-day difference was not statistically significant (P0.05). The CEUS quantitative analysis of the function parameter rise time (RT), the mean transit time (mTT), the area under the inflow phase (WiAUC), the peak intensity (PE), the inflow rate (wiR), and the inflow phase perfusion index (WiPI) were the 7th, 14th, and 42 after treatment. (4) The rise time (RT) and mean transit time (mTT) in the CEUS quantitative parameters were prolonged before the treatment (P0.05). Area under the curve (WiAUC), peak intensity (PE), inflow rate (WiR), and inflow phase perfusion index (WiPI) were There was no significant difference in the 3-day difference after treatment (P0.05), and the CEUS quantitative analysis of the function parameter rise time (RT), mean transit time (mTT), the area under the inflow phase curve (WiAUC), the peak intensity (PE), the inflow rate (wiR) and the inflow-phase perfusion index (WiPI) were the 7th and 14th after treatment. 42, Conclusion: (1) The six functional parameters (rise time (RT) and mean transit time (mTT) of the time intensity curve for the quantitative analysis of the ultrasonic contrast. , the area under the inflow phase (WiAUC), the peak intensity (PE), the inflow rate (wiR), and the inflow phase perfusion index (WiPI)) are Early prediction and evaluation of the index of the efficacy of colon cancer liver metastasis chemotherapy and targeted therapy, in which the rise time (RT) is an effective index, rise time (RT), mean transit time (mTT) for early prediction and evaluation of the efficacy of colon cancer liver metastasis chemotherapy. It is an effective index for early prediction and evaluation of the efficacy of targeted therapy for colon cancer liver metastasis. (2) The quantitative analysis of ultrasound is expected to be an early stage.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R735.34;R445.1
本文编号：2505542
[Abstract]:Purpose: To evaluate the value of the quantitative analysis of CEUS in the early prediction and evaluation of the curative effect of liver transfer chemotherapy and targeted therapy (bevacizumab in combination with chemotherapy) in colorectal cancer, and to provide the basis for the early judgment of the curative effect and the prognosis or the formulation of the treatment plan. It was reported. Methods: (1) To set the criteria for inclusion and exclusion, and to select the patients with colorectal cancer who were pre-treated by pathology and/ or cytological confirmation between 18 and 75 years of age, with the combination of chemotherapy and bevacizumab, and the ultrasound and CT images may The measured lesions; the function of non-vital organs, blood routine, liver, kidney function and heart function are basically normal, the survival time is more than 3 months, and the study is understood and signed (2) The combination of chemotherapy and bevacizumab in 61 patients with colorectal cancer (26 patients in the chemotherapy group and 35 in the combination of the bevacizumab and the chemotherapy group) was performed in 61 patients with colorectal cancer according to the standard. Routine ultrasound was performed at the 3rd, 7th, 14th, 42nd and 60th day before and after treatment. and CEUS, and at the end of the first month and the end of the second month after the treatment In line-enhanced CT,61 patients with colorectal cancer were divided into treatment effective according to the two-month evaluation of the post-treatment enhanced CT. And treatment of the invalid group. (3)6.6.6.6.6.6.6.6.6.6.3)6.6.6.6.6.6.6. The function parameters are calculated. The six functional parameters of the selected time intensity curve are rise time (RT), mean transit time (mTT), peak intensity (PE), area under the inflow phase curve (WiAUC), inflow phase slope (WiR), inflow phase irrigation, Note Index (WPI), where the rise time (RT) is the peak intensity rising from 10% The required time to 90%. The average transit time (mTT) is rising from the strength to the peak the peak intensity (pe) is the signal strength when the peak is reached, The area under the inflow phase curve (WiAUC) is the area under the rising branch of the curve and is related to the inflow Related to the amount of blood flow in the phase. The inflow phase slope (WiR) and the blood flow are the largest Flow and irrigation time-related. The inflow index (WIPI) is the inflow phase curve The lower area divided by the inflow time; (4) the modified solid tumor effect evaluation standard (mRECIST standard) was adopted to evaluate the effect of the treatment of the liver metastasis and the targeted treatment of the colorectal cancer in the treatment effective group and the treatment ineffective group, and the six quantitative parameters of the time intensity curve and the mR were analyzed. ECI Results: (1) The effective and ineffective treatment group, the rise time (RT), mean transit time (mTT) of the pre-treatment CEUS quantitative analysis, the area under the inflow phase curve (mTT). WiAUC), peak intensity (PE), inflow rate (wiR), and inflow phase perfusion index (WiPI) There was no significant difference (P0.05). (2) The rise time (RT) of CEUS quantitative analysis before and after treatment with bevacizumab in combination with chemotherapy was of statistical significance (P0.05), while the mean transit time (mTT) was below the phase curve. product (WiAUC), peak intensity (PE), inflow rate (wiR), and inflow phase perfusion index (WiP I) The difference was not significant (P0.05). The rise time (RT), mean transit time (mTT) of the pre-treatment CEUS quantitative analysis with bevacizumab in combination with chemotherapy and the inflow phase curve product (WiAUC), peak intensity (PE), inflow rate (wiR), and inflow phase perfusion index (WiP (3) The rise time (RT) in the quantitative analysis of CEUS was prolonged before the treatment (P0.05), while the mean transit time (mTT) and the inflow phase curve were not statistically significant (P0.05). The lower area (WiAUC), peak intensity (PE), inflow rate (WiR), and inflow phase perfusion index (WiPI) were treated The 3-day difference was not statistically significant (P0.05). The CEUS quantitative analysis of the function parameter rise time (RT), the mean transit time (mTT), the area under the inflow phase (WiAUC), the peak intensity (PE), the inflow rate (wiR), and the inflow phase perfusion index (WiPI) were the 7th, 14th, and 42 after treatment. (4) The rise time (RT) and mean transit time (mTT) in the CEUS quantitative parameters were prolonged before the treatment (P0.05). Area under the curve (WiAUC), peak intensity (PE), inflow rate (WiR), and inflow phase perfusion index (WiPI) were There was no significant difference in the 3-day difference after treatment (P0.05), and the CEUS quantitative analysis of the function parameter rise time (RT), mean transit time (mTT), the area under the inflow phase curve (WiAUC), the peak intensity (PE), the inflow rate (wiR) and the inflow-phase perfusion index (WiPI) were the 7th and 14th after treatment. 42, Conclusion: (1) The six functional parameters (rise time (RT) and mean transit time (mTT) of the time intensity curve for the quantitative analysis of the ultrasonic contrast. , the area under the inflow phase (WiAUC), the peak intensity (PE), the inflow rate (wiR), and the inflow phase perfusion index (WiPI)) are Early prediction and evaluation of the index of the efficacy of colon cancer liver metastasis chemotherapy and targeted therapy, in which the rise time (RT) is an effective index, rise time (RT), mean transit time (mTT) for early prediction and evaluation of the efficacy of colon cancer liver metastasis chemotherapy. It is an effective index for early prediction and evaluation of the efficacy of targeted therapy for colon cancer liver metastasis. (2) The quantitative analysis of ultrasound is expected to be an early stage.
【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R735.34;R445.1
【参考文献】
相关博士学位论文 前1条
1 曹小丽;超声造影在乳腺癌诊断及疗效评估中的应用研究[D];山东大学;2012年
本文编号：2505542
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