MR扩散加权成像对食管癌患者同步放化疗疗效的预测价值  

The prognostic value of therapeutic effect of MR-DWI in the concurrent chemoradiotherapy of esophagus cancer patients

作　　者：蒋鸣[1] 陶华[1] 沈波[2] 徐池[1] 

机构地区：[1]江苏省肿瘤医院放疗科,江苏南京210009 [2]江苏省肿瘤医院化疗科,江苏南京210009

出　　处：《现代肿瘤医学》2016年第22期3563-3567,共5页Journal of Modern Oncology

摘　　要：目的:探讨MR扩散加权成像对食管癌患者同步放化疗疗效的预测价值。方法:选取2012年6月-2014年5月在本院就诊的103例食管癌病人作为研究对象,所有患者于治疗前行磁共振的扩散加权成像(diffusion weighted imaging,DWI)检查,测量肿瘤平均、最低ADC值和最高ADC值;并于治疗前和治疗中第2、4、6周及第8周行MR检查,根据实体瘤的疗效评价标准,将患者进行疗效分组,分为治疗有效组和无效组,比较两组的各项指标,采用受试者工作特征曲线(receiver operating characteristic curve,ROC)分析治疗前ADC值预测疗效的诊断效能。结果:103例食管癌患者吞咽困难症状于2周后逐渐缓解,治疗8周后得到明显改善,癌灶较治疗前明显缩小;DWI图显示在治疗8周后患者的瘤体在逐渐缩小,病灶信号逐渐降低,与同步放化疗前相比差异具有统计学意义(P<0.05);化疗后有效组与无效组病灶厚度、病灶长径、化疗后平均ADC、最低ADC、最高ADC值差异均具有统计学意义(均P<0.05);ROC显示以肿瘤治疗前平均ADC值预测食管癌同步放化疗疗效的灵敏度、特异度、阳性似然比、阴性似然比分别是80.0%、69.7%、2.64、0.29;最低ADC值预测食管癌同步放化疗疗效的灵敏度、特异度、阳性似然比、阴性似然比分别是75.7%、78.8%、3.57、0.31;最高ADC值ROC曲线下面积0.759,临界点取2.20×10-3mm2/s,其预测食管癌同步放化疗疗效的灵敏度、特异度、阳性似然比、阴性似然比分别是94.3%、48.5%、1.83、0.12。结论:MR扩散加权成像能够较好的预测食管癌患者同步放化疗的治疗效果,有望为食管癌个体化治疗提供依据。Objective： To evaluate the prognostic value of therapeutic effect of MR diffusion weighted imaging（ DWI） in the concurrent chemoradiotherapy of patients with esophagus cancer. Methods： A total of 103 patients with esophagus cancer diagnosed in our hospital were recruited in our study. All patients underwent DWI before treatment,and the average,minimum,and maximum ADC values（ apparent diffusion coefficient） of tumor were detected. MR was conducted before treatment,2 weeks,4 weeks,6 weeks and 8 weeks during treatment. All patients were divided into two groups according to the standard of curative effect evaluation of solid tumors： effective treatment group and ineffective treatment group. Different indicators of two groups were compared. The predictive ability of ADC value before treatment was analyzed by ROC（ receiver operating characteristic curve）. Results： The dysphagia of 103 patients relieved two weeks after chemoradiotherapy,and obviously ameliorated eight weeks after chemoradiotherapy. The lesion size was obviously reduced when compared to before treatment. The DWI figure showed that the size of tumor was obviously reduced eight weeks after chemoradiotherapy,and the signal of lesion was reduced which had significant difference when compared with those before concurrent chemoradiotherapy（ P〈 0. 05）. Significant differences were found in comparison of the thickness of lesion,the length of lesion,average ADC after chemotherapy,minimum ADC after chemotherapy,and maximum ADC after chemotherapy between the two groups（ P〈 0. 05）. ROC analysis result showed that the sensitivity,specificity,positive likelihood ratio,and negative likelihood ratio predicted by the average ADC value before treatment were 80. 0%,69. 7%,2. 64,0. 29,respectively. The sensitivity,specificity,positive likelihood ratio and negative likelihood ratio predicted by the minimum ADC value before treatment were 75. 7%,78. 8%,3. 57,0. 31,respectively. The area under the ROC curve of maximum ADC value was 0. 759. The s

关 键 词：DWI ADC ROC 食管癌 同步放化疗 

分 类 号：R735.1[医药卫生—肿瘤]