动态对比增强MRI与扩散加权成像在评价非小细胞肺癌化疗疗效中的研究  

Dynamic contrast-enhanced MRI and diffusion weighted imaging in evaluating the early response to chemotherapy in non-small cell lung cancer

作　　者：贺小平[1] 苗重昌[1] 卞光军[1] 王德华[1] 江顺滨[1] 冯永利[1] He Xiaoping Miao Zhongchang Bian Guangjun Wang Dehua Jiang Shunbin Feng Yongli(Department of Radiology, The First People＇s Hospital of Lianyungang, Jiangsu Province, Lianyungang 222002, Chin)

机构地区：[1]连云港市第一人民医院影像科,222002

出　　处：《中华放射学杂志》2016年第10期746-751,共6页Chinese Journal of Radiology

基　　金：连云港市科技局课题（SH1533）

摘　　要：目的：探讨动态对比增强MRI（DCE-MRI）及DWI在评价非小细胞肺癌（NSCLC）化疗疗效中的应用价值。方法选择2012年9月至2014年9月病理证实为NSCLC并首次接受化疗的40例患者进行研究，在治疗前1周内及治疗后1个月应用3.0 T MRI行DCE-MRI和DWI扫描，并测量各参数值，包括最大强化率（MER）、强化斜率（slope）、廓清率（WR）和ADC值。根据化疗3个月后肿块最大径改变将患者分为有效组和无效组。应用独立样本t检验分析两组治疗前参数的差异，配对样本t检验比较治疗前后参数变化的差异，根据参数变化率行ROC曲线分析，采用Pearson回归分析法分析治疗后参数变化率与肿瘤缩小率的相关性。结果有效组（15例）治疗前ADC值、MER、slope值分别为（1.15±0.09）×10-3 mm2/s、1.13±0.28、（3.76±1.27）%，而无效组（25例）相应值分别为（1.34±0.33）×10-3mm2/s、0.78±0.16、（2.63±0.58）%，差异具有统计学意义（t值分别为2.329、3.152、4.556，P值分别为0.027、0.032、0.009），即有效组ADC值更低，MER、slope值较高。治疗1个月后有效组和无效组ADC变化率分别为（20.43±6.40）%、（2.98±1.65）%，slope变化率分别为（－61.80±19.21）%、（－30.80±11.16）%，有效组ADC值的上升率及slope值的下降率明显高于无效组，差异具有统计学意义（t值分别为3.485、3.280，P值分别为0.009、0.020）。ADC变化率的ROC曲线下面积最大（Az=0.790），诊断效能最高。化疗后ADC变化率、MER变化率和slope变化率与肿瘤最终缩小率呈正相关（r值分别为0.637、0.396、0.532，P值均〈0.05）。结论 DCE参数和ADC值对早期评价NSCLC化疗疗效具有一定的临床应用价值，ADC值能够敏感地显示肺癌化疗早期的反应。Objective To investigate the value of dynamic contrast-enhanced（DCE）-MRI and DWI for the early assessment of curative effects in NSCLC. Methods Forty patients from September 2012 to September 2014 with NSCLC proven by pathology were examined with DCE-MRI and DWI, at one week before the first chemotherapy and one month after treatment. DCE parameters （MER, slope, WR） and ADC values of the tumors were calculated on the workstation. According to the changes of the tumor-size after treatment, all patients were divided into two groups： good response group and poor response group. Pretreatment parameters were compared between the two groups with independent-samples t test, and parameter changes before and after treatment were compared with paired-samples t Test. ROC curve of tumor response characteristic was analyzed. Pearson correlation coefficient was used to study the correlation between post-treatment parameter changes and tumor size reduction. Results Pretreatment ADC, MER and slope value were （1.15 ± 0.09） × 10-3 mm2/s, 1.13 ± 0.28, （3.76 ± 1.27）% in the good response group（15 patients）, and were （1.34±0.33）×10-3mm2/s, 0.78±0.16, （2.63±0.58）%in poor response group（25 patients）, respectively. There was significant difference between tumors in two groups（t=2.329, 3.152, 4.556,P=0.027, 0.032, 0.009）, the lower ADC value and the higher MER/slope value was observed in the good response group. The change rates of ADC after one month treatment in the two groups were （20.43±6.40）%, （2.98±1.65）%（t=3.485,P=0.009）, and slope change were （-61.80±19.21）%, （-30.80±11.16）%（t=3.280, P=0.020）. Both the rising rate of ADC and decreasing rate of slope value were significant higher in good response group than the poor response group. The ROC curve was used to analyze the change rate of ADC and slope after tumors treatment, the area under the ROC curve in ADC was largest（Az=0.790）, the diagnosis efficiency was highest. We found significant positive correlat

关 键 词：肺癌 磁共振成像 治疗效果 

分 类 号：R445.2[医药卫生—影像医学与核医学] R734.2[医药卫生—诊断学]