胰十二指肠局部切除术后晚期直肠癌患者放化疗预后与MRI指标的关联研究  

Relationship between chemoradiotherapy prognosis and MRI index in patients with advanced rectal cancer after pancreaticoduodenectomy

作　　者：宋黎涛[1] SONG Li-tao(Seventh People＇s Hospital of Shanghai University of TCM,Shanghai 200137,China)

机构地区：[1]上海中医药大学附属第七人民医院医学影像科,上海200137

出　　处：《中国实验诊断学》2018年第10期1679-1683,共5页Chinese Journal of Laboratory Diagnosis

摘　　要：目的探讨胰十二指肠局部切除术后晚期直肠癌患者放化疗预后与MRI指标的相关性。方法使用TexRAD,采用T2加权对化疗前和化疗6周后MRI的过滤直方图技术进行纹理分析(TA)。在轴向图像上手动描绘包含肿瘤最大横截面积的感兴趣区域,并且过滤步骤在不同解剖尺度(精细,中等和粗糙)下提取特征,统计特征(平均强度,标准偏差,熵,偏度,峰度和正像素平均值)。Cox多元回归分析确定了包括组织学,放射学和组织学独立预测的总体生存期(OS),无病生存期(DFS)和无复发生存期(RFS)的单变量特征。结果 MPP(纹理细腻,风险比6.9,95%CI:2.43-19.55,P<0.001),平均(中等纹理,HR 5.6,95%CI:1.4-21.7,P=0.007)和室壁静脉入侵(HR 2.96,95%CI:1.04-8.37,P=0.041)独立预测OS,平均值(中等纹理,HR 4.53,95%CI:1.58-12.94,P=0.003)、MPP(纹理细腻,HR 3.36,95%CI:1.36-8.31,P=0.008)和预期的圆周切除边缘(HR 3.1,95%CI:1.01-9.46,P=0.046)预测DFS。对于OS,MRI上的EMVI(HR 4.23,95%CI:1.41-12.69,P=0.01)以及MRI上的DFS峰度(中等纹理,HR3.97,95%CI:1.44-10.94,P=0.007)和CRM累及(HR 3.36,95%CI:1.21-9.32,P=0.02)是独立的治疗后因素。只有TA独立预测治疗前或治疗后分析的RFS。结论基于MR的直肠癌TA可在手术前预测结果,有助选择适合患者的个体化治疗。Objective To investigate the correlation between chemoradiotherapy prognosis and MRI index in patients with advanced rectal cancer after pancreaticoduodenectomy.Methods Using TexRAD,T2 weighted method was used for texture analysis（TA）before filtration and MRI after 6 weeks of chemotherapy.The region of interest that contains the maximum cross section of the tumor is manually depicted on the axial image,and the filtering steps are extracted at different anatomical scales（fine,medium and rough）,and then the histogram analysis is used to quantify the statistical features（average intensity,standard deviation,entropy,deviation,kurtosis,and positive pixel mean.Cox multivariate regression analysis identified the overall survival time（OS）that included histology,Radiology,and histology,and the single variable characteristics of the disease-free survival（DFS）and the non recurrent survival（RFS）.Results MPP [fine texture,hazard ratio（HR）6.9,95% CI：2.43-19.55,P〈0.001],mean（medium texture,HR 5.6,95%CI：1.4-21.7,P=0.007）and extramural venous invasion（EMVI）on MRI（HR 2.96,95% CI：1.04-8.37,P=0.041）independently predicted OS while mean（medium texture,HR 4.53,95% CI：1.58-12.94,P=0.003）,MPP（fine texture,HR 3.36,95% CI：1.36-8.31,P=0.008）and threatened circumferential resection margin（CRM）on MRI（HR3.1,95% CI：1.01-9.46,P=0.046）predicted DFS.For OS,EMVI on MRI（HR 4.23,95% CI：1.41-12.69,P=0.01）and for DFS kurtosis（medium texture,HR 3.97,95% CI：1.44-10.94,P=0.007）and CRM involvement on MRI（HR3.36,95% CI：1.21-9.32,P=0.02）were the independent post-treatment factors.Only TA independently predicted RFS on pre-or post-treatment analyses.Conclusion Rectal cancer TA based on MR can predict the outcome before surgery and help to select individualized treatment for patients.

关 键 词：纹理分析 生物标志物 直肠癌 新辅助放化疗 磁共振成像 

分 类 号：R735.37[医药卫生—肿瘤]