动态增强MRI定量评估喉及下咽鳞癌同步放化疗近期疗效研究  

Dynamic contrast enhanced MRI in predicting early response of laryngeal and hypopharyngeal squamous cell carcinoma after concurrent chemoradiation therapy

作　　者：郭炜[1] 罗德红[1] 李琳[1] 赵燕风[1] 林蒙[1] 杨亮[1] 胡镭[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,北京100021

出　　处：《放射学实践》2016年第8期685-688,共4页Radiologic Practice

摘　　要：目的:探讨MRI动态增强扫描(DCE-MRI)对喉及下咽鳞癌同步放化疗近期疗效的预测价值。方法:2014年12月-2015年12月经本院喉镜活检病理证实并行同步放化疗的喉(10例)及下咽(26例)鳞癌患者共36例,于治疗前行DCE-MRI检查,并在放疗剂量累积达50Gy时行治疗中MRI复查。根据治疗结束后肿瘤缓解情况,将患者分为完全缓解组(CR)及部分缓解组(PR)。测量DCE-MRI定量参数值,包括容积转移常数(Ktrans)、速率常数(Kep)和血管外细胞外容积分数(Ve),分别比较三者在CR组与PR组间的差异,并绘制ROC曲线评估各定量参数预测喉及下咽鳞癌同步放化疗近期疗效的效能。结果:36例患者在同步放化疗后达CR20例,PR16例。喉癌和下咽癌两组间治疗前DCE-MRI各定量参数比较,差异均无统计学意义(P>0.05)。CR组治疗前Ktrans、Kep和Ve值分别为(0.307±0.055)min-1、(0.527±0.114)min-1和0.587±0.045,PR组的相应值分别为(0.234±0.049)min-1/min、(0.390±0.090)min-1和0.602±0.037。两组比较,Ktrans和Kep的差异均有统计学意义(P<0.05),Ve的差异无统计学意义(P>0.05)。ROC曲线分析,以Ktrans=0.283min-1为阈值,预测同步放化疗后达CR的曲线下面积(AUC)、敏感度及特异度分别为0.839、70.0%和81.2%;以Kep=0.446min-1为阈值,预测同步放化疗后达CR的AUC、敏感度及特异度分别为0.809、75.0%和75.0%。结论:DCE-MRI定量参数有助于预测喉及下咽鳞癌同步放化疗的近期疗效。Objective：To assess the value of dynamic contrast enhanced magnetic resonance imaging （DCE-MRI） per- formed before treatment in predicting the early response of laryngeal and hypopharyngeal carcinoma after concurrent chemo- radiation therapy. Methods： Thirty-six patients with pathologically proven laryngeal （n = 10） or hypopharyngeal （n = 26） squamous cell carcinoma received concurrent chemoradiation treatment. All patients underwent DCE-MRI before treatment to obtain the quantitative parameters of the tumors, including volume transfer constant （Ktrans）, exchange rate constant （Ko,） ,and extravaseular extracellular space volume ratio （Ve）. After received 50Gy of radiation therapy, the patients were re-examined with routine MR1. According to the tumor response,the patients were divided into CR and PR group. Results： After chemo-radiation,20 cases were divided into CR group, and 16 cases were in PR group. There were no significant differences of DCE-MRI parameters between laryngeal and hypopharyngeal cancer （P〉0.05）. The pretreatment values of K Kep ,and Vewere（0. 307±0. 055）/min, （0. 527!0. ]14）/min,and 0. 587±0. 045 in CR group,and in PR group they were （0. 234±0. 049）/min, （0. 390±0. 090）/min and 0. 602±0. 037. There was no significant difference of Ve between CR and PR group （P〉0. 05） ,however significant difference was found in K and Kop between the two groups （P〈0.05）. Receiver operating characteristic curve （ROC） analysis revealed that the threshold value of Ktrans was 0. 283/min to distin- guish between CR and PR, the corresponding AUC, sensitivity, and specificity were 0. 839,70.0 % and 82.5%, respectively. Setting Kep value of 0. 446/min as threshold to distinguish CR and PR, the AUC, sensitivity and specificity were 0. 809,75 % and 750%,respectively. Conclusion： Pretheraputic DCE-MRI and quantifying parameters are helpful to predict the early re- sponse of laryngeal and hypopharyngeal squamous cell carcinoma after concurrent chemo

关 键 词：喉肿瘤 下咽肿瘤 鳞癌 磁共振成像 动态增强扫描 放化疗 

分 类 号：R445.2[医药卫生—影像医学与核医学] R739.63[医药卫生—诊断学]