扩散加权成像对鼻咽癌放化疗疗效的预测价值  

Value of Magnetic Resonance Diffusion-Weighted Imaging for the Prediction of Chemoradiotheray Efficacy in Nasopharyngeal Carcinoma

作　　者：郭笑寒[1] 孔祥林[2] 田兴仓[2] 李文玲[2] 孙潇[3] 朱力[2] GUO Xiaohan KONG Xianglin TIAN Xingcang et al(Department of Radiology,Tangdu Hospital of the Fourth Military Medical University, Xi＇ an, Shanxi Province 710038, ,P. R. China)

机构地区：[1]第四军医大学唐都医院放射科,西安710038 [2]宁夏医科大学总医院放射科,银川750004 [3]宁夏医科大学,银川750004

出　　处：《临床放射学杂志》2017年第1期28-33,共6页Journal of Clinical Radiology

摘　　要：目的探讨扩散加权成像(DWI)对鼻咽癌放疗疗效的预测评估价值。方法搜集经病理证实并于本院接受放化疗的鼻咽癌患者37例,于治疗前行常规MRI及DWI扫描(b值取0、800 s/mm^2),分别测量肿瘤平均、最高及最低表观扩散系统(ADC)值;于治疗中期再次行磁共振扫描求得肿瘤消退率,并以此为依据将患者分为三组,对治疗前肿瘤ADC值与肿瘤消退率进行相关性分析,并采用受试者工作特征曲线(ROC)计算治疗敏感及抗拒的阈值和诊断效能。结果全部肿瘤平均及最高ADC值与肿瘤消退率呈低度(r值-0.277,P<0.05)及中度(r值-0.642,P<0.05)负相关,最低ADC值与肿瘤消退率相关性无统计学意义。ROC显示以肿瘤最高ADC值<1.247×10^(-3)为诊断完全缓解组的阈值,其敏感度为85.7%,特异度为86.7%,曲线下面积为0.833。以肿瘤最高ADC值>1.394×10^(-3)为诊断治疗抗拒组的阈值,其敏感度为57.1%,特异度为83.3%,曲线下面积为0.717。结论DWI-MRI可以早期预测鼻咽癌放化疗的疗效,有助于对患者制定个体化治疗方案。Objective To prospectively evaluate the efficacy of pre-treatment DWI and ADC for treatment response to chemoradiotherapy（ CRT） of Nasopharyngeal Carcinoma. Methods 37 patients with confirmed NPC by biopsy pathology examination underwent MRI and DWI（ b value = 0,800 s / mm^2） before concurrent chemoradiation. Calculation of the mean,maximum and minimum area of the ADC values was done. During treatment（ receiving dose of 56Gy）,patients were reexamined with MRI and the tumor regression rate was also measured. Patients were classified into three groups as complete response,partial response and stable disease,based on RECIST 1. 1. Spearman correlation analysis was examined between the pre-treatment mean,maximum and minimum area of the ADC values and regression rate,respectively. The predictive value of the ADC was also examined with ROC curve. Results There was a significant negative correlation between tumor regression rate and both mean（ r =- 0. 277,P〈0. 05） and maximum（ r =- 0. 642,P〈0. 05） area of ADC values. There is no relationship between minimum area of the ADC values and tumor regression rate. AUC = 0. 833 with a sensitivity of 85. 7% and specificity of 86. 7% was observed in differentiating responders（ n = 7） from non-responders（ n= 30） when ADC values 1. 247 × 10^-3mm^2/ s. When ADC values 1. 394 × 10^-3mm^2/ s,we observed AUC = 0. 717 with sensitivity and specificity is 57. 1% and 83. 3% respectively in differentiating resistant（ n = 7） from others（ n = 30）.Conclusion DWI-MRI before treatment was capable to predict early treatment efficacy during concurrent chemoradiation in nasopharyngeal carcinoma and this outcome has potential to aid in individualized therapy.

关 键 词：鼻咽癌 扩散加权成像 放化疗 疗效评估 

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]