MRI评价同步放化疗治疗食管癌患者疗效及预后的临床价值  

Clinical Value of MRI in Evaluating the Curative Effect and Prognosis of Patients with Esophageal Cancer Treated with Concurrent Chemoradiotherapy

作　　者：王铮[1] 胡述提[1] 张洁[1] 张蓉蓉 WANG Zheng;HU Shu-ti;ZHANG Jie(Department of Thoracic Surgery,the Affiliated Hospital of Zhengzhou University(the Central Hospital of Nanyang City),Nanyang 473000,Henan Province,China)

机构地区：[1]郑州大学附属医院(河南省南阳市中心医院)胸外科,河南南阳473000 [2]郑州大学附属医院(河南省南阳市中心医院)急诊外科,河南南阳473000

出　　处：《中国CT和MRI杂志》2018年第12期81-83,共3页Chinese Journal of CT and MRI

摘　　要：目的探讨磁共振弥散加权成像(MRI-DWI)表观弥散系数(ADC值)和磁共振动态对比增强(MRI-DCE)参数对放化疗同步治疗食管癌患者疗效及预后的临床评估价值。方法选择我院收治的食管癌患者70例,均进行放化疗,记录放化疗效果,并于放化疗前后进行MRI-DWI和MRIDCE检查,获取MRI-DWI扫描ADC值和MRIDCE扫描定量参数[容量转移常数(Ktrans)、血管外细胞外间隙容积比(Ve)、速率常数(Kep)],比较不同疗效组以及不同预后组相关参数值,并以ROC曲线评估相关参数预测食管癌放化疗同步治疗效果。结果CR组放化疗前ADC值、Ktrans均大于PR组(P<0.05),Ve、Kep与PR组均无显著差异(P>0.05)。ROC曲线分析显示,放化疗前Ktrans=0.29/min为阈值,预测食管癌同步放化疗疗效CR的曲线下面积、敏感度、特异度分别为0.840、70.0%、81.5%;放化疗前ADC值=1.59×10-3mm2/s为阈值,预测食管癌同步放化疗疗效CR的曲线下面积、敏感度、特异度分别为0.811、76.0%、76.0%。治疗后3年生存组ADC值、Ktrans均大于治疗后3年死亡组(P<0.05),Ve、Kep与治疗后3年死亡组均无显著差异(P>0.05)。结论 MRI-DWIADC值和MRIDCE Ktrans有助于评估放化疗同步治疗食管癌患者疗效及预后。Objective To explore the clinical value of the apparent diffusion coefficient(ADC)and dynamic-contrast enhancement(MRI-DCE)parameters of magnetic resonance diffusion-weighted imaging(MRI-DWI)in evaluating the curative effect and prognosis of patients with esophageal cancer treated with concurrent chemoradiotherapy.Methods Seventy patients with esophageal cancer admitted to the hospital during the period were selected.All of them underwent concurrent chemoradiotherapy and the effects were recorded.MRI-DWI and MRI-DCE were performed before and after chemoradiotherapy to obtain the ADC value of MRI-DWI scan and quantitative parameters of MRI-DCE scan[capacity transfer constant(Ktrans),extravascular extracellular space to volume ratio(Ve),rate constant(Kep)].The relevant parameters were compared between groups with different curative effect and different prognosis.The ROC curve was used to evaluate the effects of relevant parameters in predicting the curative effect of concurrent chemoradiotherapy.Results The ADC value and Ktrans of CR group were higher than those of PR group(P<0.05),but there was no significant difference in Ve or Kep between the two groups(P>0.05).ROC curve analysis showed that Ktrans=0.29/min was the threshold before chemoradiotherapy.The area under the curve,sensitivity and specificity for predicting CR were 0.840,70.0%and 81.5%.The threshold of ADC value before chemoradiotherapy was 1.59×10^-3 mm^2/s.The area under the curve,sensitivity and specificity for predicting CR were 0.811,76.0%and 76.0%,respectively.The ADC value and Ktrans of the survival group were higher than those of the death group(P<0.05),but there was no significant difference in Ve or Kep(P>0.05).Conclusion The ADC value of MRI-DWI and Ktrans of MRI-DCE are helpful to evaluate the curative effect and prognosis of patients with esophageal cancer treated with concurrent chemoradiotherapy.

关 键 词：磁共振弥散加权成像 磁共振动态对比增强 放化疗 食管癌 疗效 预后 

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]