MRI纹理分析对局部进展期直肠癌新辅助放化疗疗效的预测价值  

MRI texture analysis in prediction of treatment response to neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer

作　　者：孟闫凯 张翀达 张红梅 赵心明 徐凯 周纯武 Meng Yankai;Zhang Chongda;Zhang Hongmei;Zhao Xinming;Xu Kai;Zhou Chunwu(Department of Radiology, National Cancer Center, Cancer Hospital, Chinese Academy of Medical Sciences ,Peking Union Medical College, Beijing 100021, China)

机构地区：[1]国家癌症中心、中国医学科学院、北京协和医学院肿瘤医院诊断科,北京100021 [2]徐州医科大学附属医院影像科

出　　处：《中华放射学杂志》2017年第12期944-948,共5页Chinese Journal of Radiology

基　　金：公益性行业科研专项（201402019）;北京市科技计划课题（Z161100000516101）;中国癌症基金会北京希望马拉松专项基金（LC2016A05）

摘　　要：目的探讨MRI纹理分析对局部进展期直肠癌新辅助放化疗疗效的预测价值。 方法回顾性分析2010年10月至2013年12月中国医学科学院肿瘤医院活检组织病理结果证实为直肠腺癌，行新辅助放化疗后行局部直肠癌全直肠系膜切除术的59例患者。新辅助放化疗前和治疗中第3周行盆腔MRI检查，测量纹理参数值（平均值、标准差、偏度、峰度、均匀性、能量和熵值）。术后按照病理T分期较治疗前是否降期，分为降期组和未降期组。采用Wilcoxon符号秩和检验比较新辅助放化疗前和治疗中纹理参数的差异。采用非参数Mann-Whitney U检验比较降期组和未降期组间纹理参数的差异，以两组间差异有统计学意义的参数为自变量，进行多参数逻辑回归分析。对多参数逻辑回归分析得出的新自变量和单一参数自变量进行ROC分析，评价参数的诊断效能。 结果28例患者治疗后出现T分期降期。治疗前和治疗中的纹理参数中，标准差、峰度和均匀性的差异有统计学意义（P均〈0.05），平均值、偏度、能量和熵值差异无统计学意义（P均〉0.05）。降期组和未降期组间，治疗前的标准差、均匀性、能量、熵值以及治疗中的平均值、熵值差异有统计学意义（P均〈0.05）。治疗前标准差、均匀性、能量、熵值预测T分期降期的ROC下面积分别为0.69、0.76、0.68和0.67，治疗中平均值、熵值预测的ROC下面积分别为0.65和0.68。对治疗前标准差、均匀性、能量、熵值4个自变量进行多参数逻辑回归分析，得到的逻辑变量1预测T分期降期的ROC下面积为0.78；对治疗中平均值、熵值2个自变量进行多参数逻辑回归分析，得到的逻辑变量2预测T分期降期的ROC下面积为0.69。 结论直肠癌新辅助放化疗前、治疗中的MRI纹理分析，具有预测疗效的价值。ObjectiveTo evaluate the value of MRI texture analysis （TA） in prediction of treatment response neoadjuvant chemoradiotherapy （nCRT） in locally advanced rectal cancer patients. MethodsFifty nine histopathologically-proven rectal adenocarcinoma patients through biopsy treated with nCRT before total mesorectal excision were enrolled in this retrospective study. The first MRI examination （pre-nCRT MRI） was performed before nCRT, and the second one （early nCRT MRI） was performed at the third week of nCRT. The texture parameters values were measured, including mean value, standard deviation, skewness, kurtosis, uniformity, energy, and entropy. Tumoral downstaging was determined by comparing the pre-nCRT clinical T stage（cT stage） with the ypT stage. The patients were divided into downstaging and non downstaging group based on postoperative T staging. Parameters were compared between pre-and early nCRT in terms of averages using Wilcoxon signed-rank test. Downstaging and non downstaging groups were analyzed using Mann-Whitney U test. Multivariate logistic regression analysis was performed using the statistically significant parameters between the two groups as independent variables. ROC analysis was performed on the new independent variables obtained by multi-parameter logistic regression analysis and the single parameter independent variables. The diagnostic efficiency of the parameters were evaluated. ResultsT-downstaging were found in 28 patients after nCRT. The stdDeviation, kurtosis, and uniformity were significantly different between pre-and early nCRT （P〈0.05）. There was no significant difference in mean value, skewness, energy, and entropy between pre-and early nCRT （P〉0.05）. The pre-nCRT, uniformity, energy, entropy and the early nCRT mean value, entropy were significantly different in patients with downstaging vs. non downstaging （P〈0.05）. For the pre-nCRT stdDeviation, uniformity, energy, entropy and the early nCRT mean value, entropy, ROC analysis showed an area u

关 键 词：直肠肿瘤 磁共振成像 治疗结果 纹理分析 

分 类 号：R445.2[医药卫生—影像医学与核医学] R735.37[医药卫生—诊断学]