DCE-MRI联合DWI评价食管癌放疗效果的价值研究  

Application of quantitative DCE-MRI combined with DWI in evaluation of response to chemoradiotherapy in esophageal cancer

作　　者：谢铁明[1] 邵国良[1] 石磊[1] 王准[2] 叶智敏[2] 朱子羽 庞佩佩 

机构地区：[1]浙江省肿瘤医院介入放射科,杭州310022 [2]浙江省肿瘤医院放疗科,杭州310022 [3]浙江中医药大学 [4]GE医疗(中国)生命科学部

出　　处：《浙江医学》2017年第24期2213-2217,共5页Zhejiang Medical Journal

基　　金：浙江省医药卫生科技计划项目(2015122839)

摘　　要：目的探讨MRI动态对比增强(DCE-MRI)联合弥散加权成像(DWI)在食管癌放疗效果评价中的应用价值。方法选取食管鳞状细胞癌患者40例,均于放疗前、第5次放疗后(放疗中)行胸部MRI平扫、DWI和DCE-MRI检查,根治性放疗后1个月复查食管吞钡造影及胸部增强CT评价疗效。按放疗后肿瘤消退情况分为完全缓解组(CR组)和部分缓解组(PR组)。比较CR组与PR组患者容量转移常数(Ktrans)、速率常数(Kep)、血管外细胞外间隙容积比(Ve)、表面扩散系数(ADC值),并比较Ktrans、Kep、Ve、ADC值对放疗效果评估的效能。结果 CR组患者29例,PR组患者11例。放疗前,CR组与PR组患者Ktra ns、ADC值比较差异均有统计学意义(均P<0.05),Kep、Ve比较差异均无统计学意义(均P>0.05)。放疗中,Ktrans、Kep比较差异均有统计学意义(均P<0.05),Ve、ADC值比较差异均无统计学意义(均P>0.05)。患者放疗前Ktra ns、ADC值,及放疗中Ktra ns、Ke p对放疗效果评估均有较高的灵敏度和特异度。结论 DCE-MRI联合DWI可以更早地对食管癌放疗效果进行评价,以便及时调整放疗剂量和治疗方案,达到个体化精准治疗。Objective To assess the application of quantitative dynamic contrast- enhanced MRI (DCE- MRI) combinedwith diffusion weighted imaging (DWI) in evaluation of early response to concurrent chemoradiotherapy (CRT) for esophagealcancer. Methods Forty patients with pathologically confirmed esophageal squamous carcinoma receiving CRT underwent plainscan, DCE- MRI and DWI scans with a 3.0T MR modality. The multi- parametric MRI scans were performed before and duringCRT treatment (after the 5th CRT). All the patients underwent esophageal angiography and contrast enhancement CT scans toevaluate the treatment response one month after the curative radiotherapy. The quantitative DCE- MRI parameters Ktrans, Kep,Ve and ADC of DWI in region of interest (ROI) were analyzed. The relationship between these quantitative parameters and tumorresponse was evaluated by Pearson's correlation analysis. The receiver operating characteristic curve (ROC) was used todetermine the best predictor. Results Twenty nine patients achieved complete remission (PR group) and 11 patients achievedpartial remission (PR group). There were significant differences in Ktrans and ADC (P <0.05) between two groups, but nosignificant differences in Kep and Ve (P >0.05) before treatment; while there were significant differences in Ktrans and Kep (P<0.05) during treatment, and no significant differences in Ve and ADC(P >0.05) between PR and CR groups. ROC showed that thesensitivity and specificity of Ktrans and ADC before treatment and Ktrans and Kep during treatment were high in prediction oftreatment response. Conclusion DCE- MRI combined with DWI can early predict the treatment response of radiotherapy for patients with esophageal squamous carcinoma and help adjust the therapeutic strategy to gain individualized and precisetreatment.

关 键 词：食管癌 动态对比增强 磁共振成像 弥散加权成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R735.1[医药卫生—诊断学]