MRI动态增强对鼻咽癌同步放化疗敏感性的预测研究

发布时间：2019-03-14 12:43

【摘要】：目的探讨MRI动态增强扫描(DCE-MRI)预测鼻咽癌同步放化疗敏感性的价值。方法 2009年10月至2012年6月经本院鼻咽镜活检病理证实并行同步放化疗的鼻咽癌患者共63例。所有患者于治疗前行DCEMRI,测量肿瘤平均、高强化区及低强化区时间信号强度曲线及半定量参数,包括达峰时间(TTP)、正性增强积分(PEI)、最大上升斜率(MSI)、最大下降斜率(MSD)。于放疗50 Gy再次行MR检查,依据肿瘤消退率(RS0-50)分为治疗敏感组、疗效中间组及治疗抗拒组。分析治疗前肿瘤DCE-MRI参数与RS0-50的相关性及其预测治疗敏感及抗拒的价值。结果与消退率具有统计学意义相关性的参数包括:治疗前肿瘤平均、高强化区及低强化区的曲线类型、TTP及MSD,r=-0.646~-0.746、-0.667~-0.681及0.281~0.301;平均MSI、低强化区MSI及高强化区PEI,r=0.287、0.372及-0.254。受试者工作特征曲线(ROC)分析显示以肿瘤低强化区TTP70 s为阈值预测肿瘤治疗敏感,其敏感性、特异性、阳性预测值、阴性预测值及准确性分别为100%、56.9%、36.3%、100%及65.1%;以肿瘤平均TTP70 s为阈值预测肿瘤治疗抗拒,其敏感性、特异性、阳性预测值、阴性预测值及准确性分别为100%、80.4%、54.5%、100%及84.1%。结论 DCE-MRI半定量参数能够较好地预测鼻咽癌治疗后消退情况与治疗敏感性,有望为鼻咽癌个体化治疗提供依据。
[Abstract]:Objective to evaluate the value of dynamic contrast-enhanced MRI (DCE-MRI) in predicting the chemosensitivity of concurrent radiotherapy and chemotherapy in nasopharyngeal carcinoma (NPC). Methods from October 2009 to June 2012, 63 NPC patients with concurrent radiotherapy and chemotherapy were pathologically proved by our nasopharyngoscope. The time signal intensity curves and semi-quantitative parameters were measured by DCEMRI, before treatment in all patients, including peak time (TTP), positive enhancement integral (PEI), maximal ascending slope (MSI),. Maximum descent slope (MSD). MR was performed again at 50 Gy after radiotherapy. According to the tumor regression rate (RS0-50), the patients were divided into three groups: treatment sensitive group, therapeutic intermediate group and treatment resistant group. To analyze the correlation between DCE-MRI parameters and RS0-50 before treatment and the value of sensitivity and resistance in predicting treatment. Results the parameters with statistically significant correlation with the regression rate were as follows: pre-treatment average, curve types of high and low enhancement regions, TTP and MSD,r=-0.646~-0.746,-0.667~-0.681, and 0.281 and 0.301; Mean MSI, low enhancement region MSI and high enhancement region PEI,r=0.287,0.372 and-0.254 4. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 100%, 56.9%, and 36.3%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 100%, 56.9% and 36.3%, respectively. 100% and 65.1%; The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of tumor mean TTP70 s were 100%, 80.4%, 54.5%, 100% and 84.1%, respectively. Conclusion the semi-quantitative parameters of DCE-MRI can be used to predict the regression and sensitivity of nasopharyngeal carcinoma after treatment, which may provide evidence for individualized treatment of nasopharyngeal carcinoma.
【作者单位】：北京协和医学院中国医学科学院肿瘤医院影像诊断科;
【分类号】：R445.2;R739.63

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