磁共振扩散加权成像动态监测中晚期宫颈癌放化疗疗效  

Dynamical monitoring the therapeutic response of advanced cervical cancer to concurrent chemoradiation with magnetic resonance diffusion weighted imaging

作　　者：王欢欢[1] 何健[1] 朱丽晶[2] 闫婧[2] 俞海平[1] 李茗[1] 李晨[1] 周正扬[1] 

机构地区：[1]南京大学医学院附属鼓楼医院放射科,江苏南京210008 [2]南京大学医学院附属鼓楼医院放疗科,江苏南京210008

出　　处：《实用放射学杂志》2015年第1期70-74,共5页Journal of Practical Radiology

基　　金：国家自然科学基金（81371516）;江苏省自然科学基金（BK2012531）;国家卫生和计划生育委员会基金（W201306）.

摘　　要：目的：研究磁共振扩散加权成像（DWI）在中晚期宫颈癌放化疗疗效动态监测中的应用价值。方法前瞻性纳入42例病理证实为中晚期（Ⅱb 期以上）宫颈癌拟行放化疗的患者,于放化疗前、结束时及结束后1个月行盆腔 MR 扫描。3例患者于放化疗结束后立即行手术切除,其余39例患者放化疗结束后1个月复查,28例完全缓解（CR ）,10例部分缓解（PR）,1例病灶稳定（SD）。28例 CR 中,11例于放化疗结束时病灶即完全消失（即刻反应组）,17例于放化疗结束后1个月病灶才完全消失（延迟反应组）。比较不同疗效组肿瘤最大径及表观扩散系数（ADC）的动态变化规律。结果CR 即刻反应组基线肿瘤最大径（3.6 cm±0.9 cm）显著小于 PR 组（5.3 cm±2.5 cm,P =0.046）和治疗结束时尚有病灶残留的患者（5.1 cm±1.9 cm,P =0.021）。治疗后1个月 CR 组病灶 ADC 值（1.43±10^-3 mm^2/ s±0.04）显著高于 PR 组（1.29±10^-3 mm^2/s±0.11,P 〈0.001）。不同疗效组患者肿瘤最大径及ADC 值有不同的变化规律,且放化疗结束时肿瘤 ADC 值与最大径二者变化率存在显著相关性（r=0.421,P =0.005）。结论肿瘤最大径对于中晚期宫颈癌放化疗疗效具有一定的预测价值,不同疗效组肿瘤最大径和 ADC 值具有不同的变化趋势,肿瘤 ADC 值可以作为疗效评估的辅助指标。Objective To study the utilization of magnetic resonance （MR）diffusion weighted imaging （DWI）in monitoring the therapeutic response of advanced cervical cancer to concurrent chemoradiation.Methods Forty two women with advanced cervical cancer （≥Ⅱb）confirmed by biopsy,who would receive concurrent chemoradiation,were prospectively included in our study.Then underwent pelvic MR imaging scan prior to,immediately and one month later after the therapy on a 3.0T MR scanner.Three pa-tients underwent surgery immediately after the therapy.The remaining 39 patients,included 28 complete response （CR）,10 partial response （PR）,and 1 stable disease （SD）,reviewed one month later after the therapy.In 28 CR patients,1 1 patients fell into imme-diate response group whose lesions completely disappeared immediately after therapy and the other 1 7 cases fell into delayed response group whose lesions disappeared one month later.Maximum diameter and the apparent diffusion coefficient （ADC）values of the le-sions with different therapeutic response were monitored and compared.Results Tumor’s maximum diameter of immediate response group （3.6 cm±0.9 cm）was significantly smaller than that of delayed response group （5.3 cm±2.5 cm,P =0.046 ）and that of patients with residual lesions immediately after therapy （5.1 cm± 1.9 cm,P =0.021 ）.ADC value of CR group was significantly higher than that of PR group （1.43±10 ^-3 mm^2/s vs 1.29 ±10 ^-3 mm^2/s,P 〈0.001）one month after therapy.The dynamic change of the tumor’s maximum diameter and ADC value differed among groups with different therapeutic responses.The change rate of the tumor ADC values and maximum diameter after the therapy were significantly correlation （r=0.421,P =0.005）.Conclusion Therapeutic effect of advanced cervical cancer to concurrent chemora- diation can be partly predicted by tumor maximum diameter. Tumor’s maximum diameter and the ADC value of different＆amp;nbsp;therapeutic group have different change trend .The A

关 键 词：扩散加权成像 表观扩散系数 宫颈癌 放化疗 

分 类 号：R445.2[医药卫生—影像医学与核医学] R737.33[医药卫生—诊断学]