磁共振弥散加权成像在早期预测食管癌放疗敏感性中的应用价值  

Application of Magnetic Resonance Diffusion Weighted Imaging in Assessment of Early Response for Esophageal Carcinoma Patients Undergoing Chemoradiotherapy

作　　者：叶智敏[1,2] 谢铁明 方军[1] 林清认[1] 李开[1] 王准[1] YE Zhi-min;XIE Tie-ming;FANG Jun(Zhejiang Cancer Hospital,310022 Hangzhou,China;Zhejiang Provincial Key Laboratory of Head ＆ Neck Cancer Translational Research, Hangzhou 310022, China)

机构地区：[1]浙江省肿瘤医院,浙江杭州310022 [2]浙江省头颈肿瘤转化医学研究重点实验室,浙江杭州310022

出　　处：《肿瘤学杂志》2018年第5期453-458,共6页Journal of Chinese Oncology

基　　金：浙江省自然科学基金青年项目(LQ15H160001);浙江省自然科学基金一般项目(LY18H160031;LY17H160039);浙江省卫生厅一般计划项目(2015KYB063;2015KYB048;2016KYA051)

摘　　要：目的]探讨磁共振弥散加权（MRI-DWI）技术早期预测食管癌原发灶放疗近期疗效的临床价值,寻找食管癌放疗敏感性的＂生物标记＂。[方法]入组32例行放射治疗的食管癌患者,所有患者均于放疗前及放疗至第5次分割时接受两次MRI＋DWI检查,观察者利用脱机分析软件根据既定方法于食管癌最大横径勾画感兴趣区域（ROI）,得出相应ROI区域ADC值。测量得出治疗前及治疗期间ADC值分别标记为pre-ADC、intra-ADC,通过前后两次ADC值计算得出ΔADC值。近期疗效评价遵循RECIST 1.1标准。分析不同近期疗效患者间上述参数的差异,并分析各参数与疗效之间的Spearman秩相关系数。构建受试者工作特征曲线（ROC）用于评价各参数评价治疗疗效。[结果]32例患者中9例获得影像学完全缓解（CR）,16例获得影像学部分缓解（PR）,7例获得影像学疾病稳定（SD）。治疗前32例食管癌瘤床区测量所得pre-ADC平均值为（1.26±0.22）10-3mm2/s,放疗至第5次分割时,食管癌瘤床区测量所得intra-ADC平均值为（1.58±0.31）10-3mm2/s,治疗前、放疗至第5次时ADC差值ΔADC为（0.32±0.18）10-3mm2/s,前后两次ADC值比较差异有统计学意义（P=0.03）。ΔADC与食管癌近期治疗反应呈正相关（P=0.776,P=0.023）。[结论]DWI检查功能参数ADC值有可能成为食管癌根治性放疗近期疗效预测的＂生物标记＂。[Objective]To apply magnetic resonance diffusion weighted imaging（MR-DWI）in assessment of early response for esophageal carcinoma patients undergoing chemoradiotherapy[Methods]Thirty-two patients with esophageal carcinoma undergoing chemoratiotherapy were enrolled,and the esophageal MR-DWI examinations were performed before treatment and at the 5^（th ）fraction radiotherapy（RT）,respectively.The regions of interest（ROI）were contoured according to the stipulated rules in advance using off-line software and the value of ADC in ROIs were generated automatically.TheΔADC was calculated by subtracting the pre-ADC（before treatment）value from the intra-ADC（at the 5^（th）fraction）value.Short-come response of treatment was based on response evaluation criteria in solid tumors（RECIST 1.1）.Spearman rank correlation coefficient were acquired to estimate the correlation between short-term response and above parameters.Receptor operation characteristics（ROC）curve was constructing to estimate the predictive accuracy of above parameters.[Results]Among 32 cases,9 cases achieved complete response（CR）,16 cases achieved partial response and 7 cases achieved stable disease（SD）.The pre-ADC and intra-ADC was（1.26±0.22）10-3mm2/s and（1.58±0.31）10-3mm2/s/s respectively（P=0.03）,with aΔADC of（0.32±0.18）10-3mm2/s.TheΔADC was positively correlated with short-come response to treatment（P=0.776,P=0.023）.[Conclusion]The parameter of MR-DWI ADC may be used as a biomarker to predict short-term response of radical radiotherapy in esophageal carcinoma. Subject words：esophageal carcinoma;diffused weighed imaging;apparent diffused coefficient;

关 键 词：食管肿瘤 弥散加权成像 ADC 近期反应 

分 类 号：R735.1[医药卫生—肿瘤]