动态增强MRI定量参数评估骨肉瘤新辅助化疗疗效价值  

Quantitative dynamic contrast enhanced MRI for assessment of osteosarcoma response to neoadjuvant chemotherapy

作　　者：马焕[1] 李振辉[1] 李鹍[1] 胡早秀[2] 杨义豪[3] 陶海波[1] MA Huan;LI Zhen-hui;LI Kun;HU Zao-xiu;YANG Yi-hao;TAO Hai-bo(Third Affiliated Hospital of Kunming Medical University & Yunnan Cancer Hospital ,Kunming 650018,P. R. China)

机构地区：[1]昆明医科大学第三附属医院.云南省肿瘤医院放射科,云南昆明650018 [2]昆明医科大学第三附属医院.云南省肿瘤医院病理科,云南昆明650018 [3]昆明医科大学第三附属医院.云南省肿瘤医院骨科,云南昆明650018

出　　处：《中华肿瘤防治杂志》2019年第6期421-426,共6页Chinese Journal of Cancer Prevention and Treatment

基　　金：云南省科技厅-昆明医科大学应用基础研究联合专项(2018FE001-065;2017FE467-084);云南省教育厅科学研究基金(2018JS223)

摘　　要：目的骨肉瘤患者新辅助化疗(neoadjuvant chemotherapy,NAC)疗效评估对于术后化疗方案的制定及预后判断具有重要意义。本研究旨在探讨动态增强MRI(dynamic contrast-enhanced MRI,DCE-MRI)定量参数在骨肉瘤NAC前后的变化及其疗效评估中的价值。方法对昆明医科大学第三附属医院·云南省肿瘤医院2015-06-01-2017-12-3017例原发性骨肉瘤患者,于NAC前、后进行常规MR及动态增强检查。将动态增强图像数据输入商用灌注软件包Omni-Kinetics 2.10计算化疗前、后定量灌注参数容量转移常数(volume transfer constant,Ktrans)、速率常数(rate constant,Kep)、血管外细胞外间隙容积分数(extravascular extracellular volume fraction,Ve)。同时,使用Siemens Sygno(MR B19)工作站及软件包计算化疗前、后肿瘤体积。依据Holscher法评价化疗疗效,并依此将病灶分为反应良好组和反应差组。采用配对样本t检验比较各组化疗前、后各灌注参数是否存在差异;采用独立样本t检验比较2组化疗前、后各灌注参数。结果化疗反应良好组7例,反应差组10例。反应良好组Ktrans(t=8.693,P<0.001)、Kep(t=3.362,P=0.015)在化疗前后差异有统计学意义;Ve在化疗前后差异无统计学意义,t=0.019,P=0.985。反应差组Ktrans(t=2.018,P=0.074)、Kep(t=1.701,P=0.123)和Ve(t=1.963,P=0.081)在化疗前后差异均无统计学意义。化疗前反应良好组和反应差组Ktrans(t=1.961,P=0.069)、Kep(t=1.488,P=0.177)和Ve(t=0.664,P=0.517)差异无统计学意义。化疗后反应差组Ktrans高于反应良好组,t=3.335,P=0.005;2组间Kep(t=1.034,P=0.317)、Ve(t=0.829,P=0.420)差异无统计学意义。由受试者工作特征(receiver operating characteristic curve,ROC)曲线分析可得,化疗后病灶Ktrans对化疗反应差的预测能力最高,其最佳临界值为0.831min-1,敏感度为80.0%(8/10),特异度为7/7,曲线下面积(area under curve,AUC)为0.943,P<0.05。结论骨肉瘤NAC反应良好者动态增强磁共振定量参数OBJECTIVE Evaluation of neoadjuvant chemotherapy(NAC)in patients with osteosarcoma is of great significance for the development of postoperative chemotherapy and prognosis.The aim of this study was to investigate the change of quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)before and after NAC in osteosarcoma and to explore the value of DCE-MRI for assessing the response to NAC.METHODS Seventeen patients with osteosarcoma were examined in this study in the Third Affiliated Hospital of Kunming Medical University &Yunnan Cancer Hospital from June 1,2015 to December 30,2017.DCE and Magnetic resonance(MR)images were obtained from all patients before and after neoadjuvant chemotherapy.The quantitative perfusion data and the gross tumor volume pre-and post-chemotherapy was calculated.The data included Ktrans(volume transfer constant),Kep(reflux rate constant),and Ve(extravascular extracellular volume fraction).The chemotherapeutic efficacy was evaluated by Holscher’s method.All lesions were divided into the good response group and the poor response group.Paired-samples T test was used to compare the perfusion parameters before and after chemotherapy.Independent-samples T test was used to compare the perfusion parameters between the good and poor response group.RESULTS There were seven cases with a good response to chemotherapy and ten cases with poor response.For the good response group,Ktrans(t=8.693,P<0.001)and Kep(t=3.362,P=0.015)were significantly decreased after neoadjuvant chemotherapy,but the Ve(t=0.019,P=0.985)has no statistical difference.There was no statistical difference in Ktrans(t=2.018,P=0.074),Kep(t=1.701,P=0.123),and Ve(t=1.963,P=0.081)pre-and post-chemotherapy for the poor response group.The grouping comparison before chemotherapy demonstrated that there was no statistical difference in all parameters between two groups,including Ktrans(t=1.961,P=0.069),Kep(t=1.488,P=0.177),Ve(t=0.664,P=0.517)respectively.The grouping comparison after chemotherapy:Ktrans(t=3.

关 键 词：骨肉瘤 新辅助化疗 磁共振成像 动态增强 灌注成像 

分 类 号：R738.6[医药卫生—肿瘤]