半定量和定量动态增强磁共振成像评价非小细胞肺癌同步放化疗敏感性的初步研究  

Preliminary study of semi-quantitative and quantitative dynamic contrast-enhanced MRI in evaluating the response to concurrent chemoradiotherapy in patients with non-small cell lung cancer

作　　者：陶秀丽[1] 欧阳汉[1] 吴宁[1] 刘莉[1] 叶枫[1] 宋颖[1] 吴培华[1] 吕律[1] 

机构地区：[1]北京协和医学院中国医学科学院肿瘤医院影像诊断科,100021

出　　处：《中华肿瘤杂志》2015年第4期272-277,共6页Chinese Journal of Oncology

基　　金：北京协和医学院博士创新基金（2013-1002-20）;国家高技术研究发展计划（2014AA020602）;国家重大仪器专项课题（201YQ1706710）

摘　　要：目的探讨多期动态增强磁共振成像（DCE—MRI）半定量和定量参数在评价非小细胞肺癌（NSCLC）同步放化疗敏感性中的作用。方法对24例经病理证实为局部晚期NSCLC（ⅢA、ⅢB期）、拟行同步放化疗的患者，于治疗前行3．0T多期DCE—MRI扫描。应用Functool和Omnikinetics软件计算DCE—MRI半定量参数和定量参数。采用Spearman等级相关分析评价各参数与治疗终肿瘤消退率的相关性。根据治疗终肿瘤退缩率将患者分为治疗敏感组和不敏感组，比较敏感组和不敏感组治疗前半定量和定量参数的差异。应用受试者工作特征曲线分析治疗前参数的临界值和效能。结果NSCLC治疗终肿瘤消退率与达峰时间（TTP）、血管外细胞外间隙容积比（Ve）呈负相关（均P〈0．05），与最大信号增强比率（SERmax）、容量转移常数（K^trans）呈正相关（均P〈0．05）。敏感组TTP和Ve值分别为（34．66±16．37）S和0．19±0．03，不敏感组分别为（44．09±17．41）s和0．25±0．05，差异均有统计学意义（均P〈0．05）。敏感组SERmax和K^trans。分别为（166．50±44．95）％和（0．41±0．17）min^-1，不敏感组分别为（113．57±46．62）％和（0．28±0．12）min^-1，差异均有统计学意义（均P〈0．05）。以肿瘤治疗前Ve值0．21为临界值，预测同步放化疗敏感性最佳，其敏感度、特异度和准确性分别为85．7％、80．0％和83.3％，曲线下面积为0．875（P〈0．001）。结论DCE—MRI半定量参数与定量参数均有助于评价非小细胞肺癌消退情况。Objective To investigate the capability of semi-quantitative and quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging （DCE-MRI） to predict the response to concurrent chemoradiotherapy（CCRT） in patients with non-small cell lung cancer （NSCLC）. Methods A total of 24 patients with stage ⅢA or ⅢB NSCLC, who underwent 3.0T DCE-MRI before CCRT, were enrolled in this study. Semi-quantitative and quantitative parameters were calculated by Funtool and Omnikinetics software. The relationship between these obtained parameters and tumor response was evaluated by Spearmen＇ s correlation analysis. The patients were classified into two groups according to the tumor regression rate after treatment, as response group （group A） and non-response group （group B）. Mann-Whitney U test was used to compare the parameters of responders and non-responders. The value of the parameters on predicting response was calculated by receiver operating characteristic curve （ ROC ）. Results The tumor regression rate after treatment was negatively correlated with time to peak （TFP） and the extravascular-extracellular volume fraction （Vo）, and was positively correlated with signal enhancement ratio （SERmax ） and volume transfer constant （K ） （P〈0.05 for all）. Statistical significant differences were found between group A and group B both in semi-quantitative and quantitative parameters （P〈0.05）, Group A had a lower TTP value [ （34.66±16.37）s vs. （44.09±17.41）s3 and Vo value [（0.19±0.03） vs. （0.25±0.05）1 than group B, whereas group A had a higher SERes[ （ 166.50±44.95）% vs. （ 113.57±46.62）%1 and K^trans [ （0.41±0.17） min^-1 vs. （0.28±0.12） min^-1] than group B （P〈0.05 for all）. The ROC analysis indicated that when setting the threshold of Vo on ≤0.21 for predicting response, the specificity, sensitivity and accuracy were 85.7 %, 80. 0 % and 8 3.3 %, respectively, with an area under curve of 0.8 7 5 （ P 〈0. 0 01 ）. C

关 键 词：肺肿瘤 磁共振成像 放射疗法 抗肿瘤联合化疗方案 治疗结果 

分 类 号：R734.2[医药卫生—肿瘤] R445.2[医药卫生—临床医学]