扩散加权成像在预测直肠癌术前放化疗疗效中的价值  

Value of diffusion-weighted magnetic resonance imaging in prediction of the response to preoperative chemoradiotherapy in rectal carcinoma

作　　者：梁晓[1] 张红梅[1] 叶枫[1] 欧阳汉[1] 赵心明[1] 周纯武[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》2016年第2期133-137,共5页Chinese Journal of Oncology

基　　金：北京希望马拉松临床研究重点课题（LC2010A12）

摘　　要：目的探讨扩散加权成像（DWI）在预测直肠癌术前放化疗疗效中的价值。方法2007--2012年间前瞻性纳入经病理证实并在术前行放化疗的直肠癌患者86例，治疗前均行常规磁共振成像（MRI）及DWI检查，部分患者行治疗中、治疗后MRI及DWI检查。分别测量患者治疗前、治疗中和治疗后的肿瘤表观扩散系数（ADC）。将术后病理T分期与治疗前MRI临床T分期进行比较，分期降低者为T-降期组，分期不变者为T-未降期组。统计分析肿瘤治疗前、治疗中和治疗后ADC及其不同组间ADC的差异。结果手术后病理分期为T0期20例，T1期2例，T2期17例，T3期44例，T4期3例。T-降期组39例，其中无肿瘤残存18例；T-未降期组47例。86例患者治疗前、治疗中和治疗后的ADC分别为（1．03±0．17）×10^-3、（1．39±0．28）×10^-3和（1．61±0．27）×10^-3mm2／s，差异有统计学意义（P〈0．001）。T-降期组和T-未降期组患者治疗前ADC分别为（1．04±0．19）×10^-3和（1．03±0．15）×10^-3mm2／s，差异无统计学意义（P=0．615）。43例患者同时行治疗前、治疗中和治疗后DWI检查，其ADC分别为（1．05±0．16）×10^-3、（1．39±0．29）×10^-3和（1．67±0．30）×10^-3mm2／s，差异有统计学意义（P〈0．001）。结论随着放化疗的进行，直肠癌患者的肿瘤ADC逐渐升高。治疗前的肿瘤ADC尚不能准确预测局部晚期直肠癌患者的放化疗疗效。Objective To investigate the value of diffusion weighted imaging （DWI） in predicting the efficacy of preoperative ehemoradiotherapy （CRT） for locally advanced rectal cancer. Methods From 2007 to 2012,86 patients with histopathologieaIly proven rectal cancer who underent pre-CRT were enrolled in this study prospectively.Diffusion-weighted MR1 was performed in all patients before pre-CRT, while it was performed in part of the patients during and after pre-CRT as well.ADC values of the tumors were calculated on the workstation. Patients were assigned to the tumor downstaged group or the tumor nondownstaged group on the basis of T staging. The change in ADC following treatment and the difference in ADC between groups were analyzed. Results Of the 86 patients after surgery, 20 were diagnosed with T0, 2 with T1, 17 with T2, 44 with T3 and 3 with T4. 39 patients were classified as the downstaged group, of which 18 were of pCR. The remaining 47 patients were classified as the nondownstaged group. Of the total of 86 patients, the mean ADC values before, during, and after pre-CRT （pre-ADC, during-ADC, and post-ADC） were （1.03±0.17）×10^-3, （1.39±0.28） ×10^-3, and （1.61±0.27） ×10^-3 mm2/s and there was a significant difference （P〈0.001）. However, the pre-CRT ADC of the downstaged group did not differ significantly from that of the nondownstaged group （P= 0.615）. Of the 43 patients who underwent MRI before, during and after pre-CRT, the meanADC values were （1.05±0.16）×10^-3, （1.39±0.29）×10^-3and （1.67±0.30）×10^-3 mm2/s, respectively, showing a significant difference （P〈 0. 001 ） as well. Conclusions The mean ADC value of rectal cancer is gradually increasing along with the course of chemotherapy. Pre-ADC is not a good parameter to be used to predict the efficacy of pre-CRT for locally advanced rectal cancer.

关 键 词：直肠肿瘤 磁共振成像 治疗结果 表观扩散系数 

分 类 号：R445.2[医药卫生—影像医学与核医学] R735.37[医药卫生—诊断学]