射波刀治疗局部进展期胰腺癌疼痛的近期疗效及DWI的评估价值  

The value of DWI in monitoring therapeutic effects of Cyberknife on pain for locally advanced pancreatic cancer

作　　者：张瑜[1] 费剑峰 张火俊[2] 代智涛 陈炜[1] 马超[1] 陆建平[1] Zhang Yu;Fei Jianfeng;Zhang Huojun;Dai Zhitao;Chen Wei;Ma Chao;Lu Jianping(Department of Radiology,Changhai Hospital,Second Military Medical University,Shanghai 200433,China)

机构地区：[1]第二军医大学长海医院放射科,上海200433 [2]第二军医大学长海医院放疗科,上海200433 [3]海防第312旅船运中队

出　　处：《中华胰腺病杂志》2018年第3期163-166,共4页Chinese Journal of Pancreatology

基　　金：国家自然科学基金(81601468).

摘　　要：目的评估射波刀治疗局部进展期胰腺癌(LAPC)疼痛的近期疗效,探讨扩散加权成像(DWI)在疼痛评估中的应用。方法对36例LAPC患者在放疗前和放疗后1、3月进行疼痛视觉模拟评分(VAS)及生活质量评分(KPS),同时行胰腺MRI常规序列及DWI扫描。观察治疗前后VAS及KPS评分的变化,DWI图像上感兴趣区(ROI)的表观扩散系数(ADC)值的变化,分析ADC值与VAS、KPS评分的相关性。结果射波刀治疗前和治疗后1、3月的VAS分别为(4.89±2.89)、(1.08±2.06)、(0.51±1.48)分;KPS评分分别为(72.47±14.74)、(93.33±10.69)、(92.86±10.73)分;DWI的ADC值分别为1.47±0.28、1.79±0.33、1.94±0.41,差异均有统计学意义(P值均<0.001)。其中射波刀治疗后1、3月的VAS评分较治疗前显著降低,KPS评分及ADC值较治疗前显著升高,差异均有统计学意义(P值均<0.05),而治疗后1、3月间的差异均无统计学意义。治疗后1、3月的ADC值与VAS、KPS评分间均无明显相关性。结论射波刀治疗后短期内患者疼痛明显缓解,生活质量明显改善,但DWI的ADC值尚不能灵敏地反映疼痛的变化。ObjectiveTo evaluate the short-term therapeutic efficacy of Cyberknife in alleviating the pain of locally advanced pancreatic cancer (LAPC) and explore the application of DWI in the pain evaluation.MethodsVisual analogue scale (VAS) and Quality of life score KPS were conducted in 36 LAPC patients before and 1 month, 3 month after radiotherapy, who underwent conventional MRI examination and DWI scan. The changes of VAS and KPS scores were observed before and after the treatment, as well as the apparent diffusion coefficients (ADC) changes of region of interest (ROI) in the DWI images, and the correlation of ADC with KPS and VAS was analyzed.ResultsVAS before and at 1 month and 3 month after the treatment was (4.89±2.89), (1.08±2.06) and(0.51±1.48). KPS before and at 1 month and 3 month after the treatment was (72.47±14.74), (93.33±10.69) and(92.86±10.73). ADC of DWI before and at 1 month and 3 month after the treatment was 1.47±0.28, 1.79±0.33and1.94±0.41, and the differences were statistically significant (all P values <0.001). VAS was obviously decreased at 1 month and 3 month after the treatment, while KPS and ADC were greatly increased, and the differences were statistically significant (P value <0.05). There was no statistical difference between those at 1 month and those at 3 month. There was no obvious correlation between ADC and VAS and KPS at 1 month and 3 month after the treatment.ConclusionsAfter Cyberknife treatment, the pain was obviously relieved and the life quality was greatly improved within short period, but ADC of DWI can not sensitively monitor the changes of the pain.

关 键 词：胰腺肿瘤 放射疗法 射波刀 扩散加权成像 疼痛 

分 类 号：R445.2[医药卫生—影像医学与核医学] R730.55[医药卫生—诊断学] R735.9[医药卫生—临床医学]