DWI动态监测鼻咽癌转移性淋巴结化放疗疗效的应用研究
发布时间：2019-01-08 16:52
【摘要】：目的：通过动态监测鼻咽癌转移性淋巴结化放疗过程中表观弥散系数（ADC）值的变化，探讨弥散加权成像（DWI）对化放疗疗效的价值。 方法：研究对象为30例经穿刺活检病理证实鼻咽癌伴颈部淋巴结转移的患者，所有患者均接受铂类化疗及头颈部调强适形放射治疗（IMRT）正规鼻咽癌化放疗治疗方案。依据化放疗原则，制定MRI检查计划，分别在治疗前、治疗中每3周一次及治疗结束1个月后（即第1次化疗前1天、第2次化疗前1天、第1次放疗前1天、第15次放疗当天及第30次放疗当天、治疗结束1个月后共6次）各个时间点进行MRI常规及DWI检查。当b值取800s/mm2时，观察颈部转移性淋巴结治疗过程中ADC值的动态变化，同时治疗前淋巴结与治疗后残留的淋巴结ADC值的差异，并分别比较治疗前后两组淋巴结与正常舌肌的ADC值差异，统计学分析采用两独立样本t检验。 结果： 1.治疗前107枚淋巴结的平均ADC值[（0.789±0.022）×10-3mm2/s]明显低于治疗前正常舌肌ADC值[（1.391±0.031）×10-3mm2/s]，两者间差异具有统计学意义（t=33.3，，p0.001）。 2.治疗过程中转移性淋巴结平均ADC值逐渐上升，以第1次放疗至第15放疗期间最明显。 3.治疗后残留淋巴结的平均ADC值[1.410±0.074）×10-3mm2/s]明显增高，与治疗前淋巴结比较差异有统计学意义（t=178.0，p0.001）；与治疗后正常舌肌比较差异无统计学意义（t=0.8，p=0.445）。 结论： 1.通过MRI DWI监测鼻咽癌转移性淋巴结的ADC值的变化，结合其形态学改变，早期监测鼻咽癌转移性淋巴结化放疗疗效影像学指标成为可能，第1次放疗至第15次放疗转移性淋巴结平均ADC值变化对区分化放疗反应性较敏感，可作为有效的时间监测点，从而指导临床合理制定并及时优化化疗方案或放疗计划。 2.通过DWI动态监测鼻咽癌转移性淋巴结化放疗疗效的评估，为临床个体化提供依据，同时为研究其他肿瘤提供研究基础。 3.对不能得到病理证实的淋巴结，可通过测量ADC值对其性质提供判定依据。
[Abstract]:Objective: to investigate the value of diffusion weighted imaging (DWI) in the therapeutic effect of metastatic lymph node chemoradiotherapy for nasopharyngeal carcinoma (NPC) by monitoring the change of apparent diffusion coefficient (ADC). Methods: thirty patients with nasopharyngeal carcinoma (NPC) with cervical lymph node metastasis confirmed by biopsy were treated with platinum chemotherapy and head and neck intensity modulated conformal radiotherapy (IMRT). According to the principle of chemoradiotherapy, the plan of MRI examination was made, before treatment, once every 3 weeks during treatment and 1 month after the end of treatment (i.e. 1 day before the first chemotherapy, 1 day before the second chemotherapy, 1 day before the first radiotherapy, 1 day before the first chemotherapy, 1 day before the first radiotherapy, respectively). MRI and DWI were performed at each time point on the 15th radiotherapy day and the 30th radiotherapy day, 1 month after the end of the treatment. When b value was taken from 800s/mm2, the dynamic changes of ADC were observed during the treatment of metastatic lymph nodes in the neck, and the difference of ADC value between the pre-treatment lymph nodes and the residual lymph nodes after treatment was also observed. The ADC values of lymph node and normal tongue muscle were compared before and after treatment, and two independent samples t test were used for statistical analysis. Results: 1. The mean ADC value of 107 lymph nodes before treatment [(0.789 卤0.022) 脳 10-3mm2/s] was significantly lower than that of normal tongue muscle before treatment [(1.391 卤0.031) 脳 10-3mm2/s]. 2. The mean ADC value of metastatic lymph nodes increased gradually during the treatment, especially during the first radiotherapy to the 15th radiotherapy. 3. The mean ADC value of residual lymph nodes after treatment [1.410 卤0.074 脳 10-3mm2/s] was significantly higher than that before treatment. There was no significant difference between the normal tongue muscle and the normal tongue muscle after treatment (t 0. 8%, P < 0. 445). Conclusion: 1. MRI DWI was used to monitor the changes of ADC value in metastatic lymph nodes of nasopharyngeal carcinoma (NPC). Combined with morphological changes, it was possible to monitor the therapeutic effects of chemoradiotherapy on metastatic lymph nodes of nasopharyngeal carcinoma (NPC) at early stage. The change of mean ADC value of metastatic lymph nodes from the first to the 15th radiotherapy is sensitive to the regional differentiation and radiotherapy reactivity and can be used as an effective time monitoring point to guide clinical rational formulation and timely optimization of chemotherapy or radiotherapy plans. 2. The evaluation of therapeutic effect of metastatic lymph node chemoradiotherapy on nasopharyngeal carcinoma (NPC) by dynamic monitoring by DWI provides evidence for clinical individualization as well as research basis for other tumors. 3. For lymph nodes which can not be confirmed by pathology, the nature of lymph nodes can be judged by measuring ADC value.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R739.63
[Abstract]:Objective: to investigate the value of diffusion weighted imaging (DWI) in the therapeutic effect of metastatic lymph node chemoradiotherapy for nasopharyngeal carcinoma (NPC) by monitoring the change of apparent diffusion coefficient (ADC). Methods: thirty patients with nasopharyngeal carcinoma (NPC) with cervical lymph node metastasis confirmed by biopsy were treated with platinum chemotherapy and head and neck intensity modulated conformal radiotherapy (IMRT). According to the principle of chemoradiotherapy, the plan of MRI examination was made, before treatment, once every 3 weeks during treatment and 1 month after the end of treatment (i.e. 1 day before the first chemotherapy, 1 day before the second chemotherapy, 1 day before the first radiotherapy, 1 day before the first chemotherapy, 1 day before the first radiotherapy, respectively). MRI and DWI were performed at each time point on the 15th radiotherapy day and the 30th radiotherapy day, 1 month after the end of the treatment. When b value was taken from 800s/mm2, the dynamic changes of ADC were observed during the treatment of metastatic lymph nodes in the neck, and the difference of ADC value between the pre-treatment lymph nodes and the residual lymph nodes after treatment was also observed. The ADC values of lymph node and normal tongue muscle were compared before and after treatment, and two independent samples t test were used for statistical analysis. Results: 1. The mean ADC value of 107 lymph nodes before treatment [(0.789 卤0.022) 脳 10-3mm2/s] was significantly lower than that of normal tongue muscle before treatment [(1.391 卤0.031) 脳 10-3mm2/s]. 2. The mean ADC value of metastatic lymph nodes increased gradually during the treatment, especially during the first radiotherapy to the 15th radiotherapy. 3. The mean ADC value of residual lymph nodes after treatment [1.410 卤0.074 脳 10-3mm2/s] was significantly higher than that before treatment. There was no significant difference between the normal tongue muscle and the normal tongue muscle after treatment (t 0. 8%, P < 0. 445). Conclusion: 1. MRI DWI was used to monitor the changes of ADC value in metastatic lymph nodes of nasopharyngeal carcinoma (NPC). Combined with morphological changes, it was possible to monitor the therapeutic effects of chemoradiotherapy on metastatic lymph nodes of nasopharyngeal carcinoma (NPC) at early stage. The change of mean ADC value of metastatic lymph nodes from the first to the 15th radiotherapy is sensitive to the regional differentiation and radiotherapy reactivity and can be used as an effective time monitoring point to guide clinical rational formulation and timely optimization of chemotherapy or radiotherapy plans. 2. The evaluation of therapeutic effect of metastatic lymph node chemoradiotherapy on nasopharyngeal carcinoma (NPC) by dynamic monitoring by DWI provides evidence for clinical individualization as well as research basis for other tumors. 3. For lymph nodes which can not be confirmed by pathology, the nature of lymph nodes can be judged by measuring ADC value.
【学位授予单位】：南昌大学
【学位级别】：硕士
【学位授予年份】：2012
【分类号】：R739.63
【参考文献】
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1 胡伟汉,张国义,刘立志,吴湖炳,李立,高远红,潘q
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