体素内不相干运动成像评估局部进展期直肠癌新辅助化疗后病理完全缓解  

Intravoxel incoherent motion imaging for predicting pathological complete response of locally advanced rectal cancer after neoadjuvant chemotherapy

作　　者：徐俏宇 孙宏亮[1] 徐妍妍[1] 王武[1] 

机构地区：[1]中日友好医院放射科,北京100029

出　　处：《中国医学影像技术》2018年第3期372-377,共6页Chinese Journal of Medical Imaging Technology

基　　金：国家自然科学基金(81501469);国家卫生和计划生育委员会公益性行业科研专项(201402019)

摘　　要：目的探讨体素内不相干运动(IVIM)成像在诊断局部进展期直肠癌新辅助化疗后病理完全缓解(pCR)中的价值。方法 61例经手术病理证实为直肠腺癌患者于新辅助化疗前后分别行常规MR及多b值DWI IVIM检查,由2名医师独立测量肿瘤的ADC值及IVIM参数[真实扩散系数(D值)、灌注相关假扩散系数(D*值)、灌注分数(f值)]。将患者分为pCR组(14例)和非pCR组(47例)。采用独立样本t检验比较两组所有参数及其新辅助化疗前后变化的百分数(Δ_(ratio)),采用ROC曲线下面积评价各参数诊断pCR的效能。结果与非pCR组比较,pCR组化疗前ADC值(P=0.002)和D值(P=0.007)更低,Δ_(ratio)ADC值(P<0.001)和Δ_(ratio)D值(P=0.002)更高;两组化疗前和化疗后D*、f值及其Δ_(ratio)差异均无统计学意义(P均>0.05)。Δ_(ratio)D值诊断pCR的ROC曲线下面积最高(0.786,P<0.01)。结论 D值有助于预测和鉴别新辅助化疗后达到pCR的局部进展期直肠癌。Objective To explore the value of intravoxel incoherent motion （IVIM） analysis in evaluation of pathological complete response （pCR） in patients with locally advanced rectal cancer （LARC） after neoadjuvant chemotherapy. Methods Totally 61 patients with pathologically proven rectal adenocarcinoma were retrospectively analyzed. All patients underwent MR scan, including multi-b DWI IVIM sequence scanning before and after neoadjuvant chemotherapy. ADC values and IVIM parameters （slow diffusion coefficient[D], fast diffusion coefficient[D＊] and perfusion fraction[f]） were measured by two radiologists independently. Then the patients were divided into pCR group （n=14） and non-pCR group （n=47）. Independent-samples t test was used to compare all the parameters before and after therapy, as well as the percentage changes （Δratio） between pCR and non-pCR group. Area under the curve （AUC） was used to evaluate the diagnostic performance. Results ADC （P=0.002） and D （P=0.007） values were significantly lower before therapy, while ΔratioADC （P 〈 0.001） and ΔratioD （P=0.002） were significantly higher in pCR group compared with those in non-pCR group. D＊, f and their Δratio value were not statistically different pre-chemotherapy and post-chemotherapy in both two groups （all P〉0.05）. ΔratioD had the highest AUC （0.786, P 〈 0.01）. Conclusion IVIM-derived D values can help to predict and differentiate pCR of LARC after neoadjuvant chemotherapy.

关 键 词：直肠肿瘤 病理完全缓解 磁共振成像 体素内不相干运动 新辅助化疗 

分 类 号：R735.35[医药卫生—肿瘤] R445.2[医药卫生—临床医学]