应用剪切波弹性成像技术评价局部进展期直肠癌新辅助放化疗后病灶的初步经验  

Use of shear wave elastography in the evaluation of local advanced rectal cancer after neoadjuvant radiochemotherapy: the initial experience

作　　者：丛悦[1] 范智慧[1] 戴莹[1] 张仲一[1] 严昆[1] Cong Yue;Fan Zhihui;Dai Ying;Zhang Zhongyi;Yan Kun(Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital & Institute, Beijing 100142, China)

机构地区：[1]北京大学肿瘤医院暨北京市肿瘤防治研究所超声科恶性肿瘤发病机制及转化研究教育部重点实验室,100142

出　　处：《中华超声影像学杂志》2019年第10期901-906,共6页Chinese Journal of Ultrasonography

摘　　要：目的探讨剪切波弹性成像(SWE )技术在直肠癌放化疗后病灶评价中的应用价值.方法回顾性分析73例因局部进展期直肠癌于我院治疗的患者,于放化疗前后均接受直肠腔内超声(ERUS)及SWE检查.应用SWE测量放化疗前后病灶硬度的杨氏模量平均值及最大值,并计算放化疗前后病灶杨氏模量平均值及最大值的差值;依据术后病理 T 分期将病灶分为降期组与未降期组,计算ERUS诊断T分期降期的诊断效能,并比较两组间放化疗前后杨氏模量平均值与最大值差值的差异.分别以放化疗前后病灶杨氏模量平均值差值及最大值差值构建ROC曲线,评价差值预测放化疗后 T分期降期的诊断价值.结果与放化疗前比较,共57例直肠病灶pT分期降期(57/73 , 78 .1%).放化疗前后病灶杨氏模量平均值及最大值比较,差异有统计学意义(均 P <0 .01);放化疗后,随pT分期升高病灶硬度值增大,其中与pT3期病灶杨氏模量平均值相比, pT0 、 pT1及pT2期病灶杨氏模量平均值差异有统计学意义(均 P <0 .01),与pT3期病灶杨氏模量最大值相比, pT0 、 pT1期病灶杨氏模量最大值差异有统计学意义(均 P <0 .01).降期组与未降期组直肠病灶的杨氏模量平均值及最大值差值相比,差异有统计学意义(均 P <0 .01).建立ROC曲线并经计算确定,以平均值差值 34 .7 kPa为最佳诊断临界点,以放化疗后病灶硬度平均值下降≥34 .7 kPa判断放化疗后T分期降期,其敏感性、特异性、准确性分别为87 .7%、 93 .8%及89 .0%,与应用ERUS诊断降期相比,差异有统计学意义( P =0 .032).结论 SWE是辅助ERUS评价直肠癌放化疗后病灶的有效技术,具有良好的临床应用前景.Objective To investigate the value of shear wave elastography(SWE) to evaluate local advanced rectal cancer after neoadjuvant radiochemotherapy. Methods In a retrospective study, endorectal ultrasound(ERUS) and endorectal SWE were performed in 73 patients with local advanced rectal cancer before and after neoadjuvant radiochemotherapy. The mean and maximum values of Young′s modulus for SWE to evaluate the lesions before and after neoadjuvant radiochemotherapy were recorded. According to the postoperative pathological T stage, the lesions were divided into reduction of T stage group and non-reduction of T stage group. The efficacy of ERUS in diagnosing reduction of T stage was calculated, and the differences of the mean and maximum values of Young′s modulus between reduction of T stage group and non-reduction of T stage group was calculated, and the differences between the two groups were compared. ROC curves were constructed by the difference of mean and maximum Young′s modulus of lesions before and after neoadjuvant radiochemotherapy, respectively, to evaluate the diagnostic value of the difference in predicting reduction of T stage. Results A total of 57 cases had reduction of T stage after neoadjuvant radiochemotherapy (57/73, 78.1%). The mean and maximum values of Young′s modulus before and after neoadjuvant radiochemotherapy were compared, and the differences were statistically significant(all P<0.01). After neoadjuvant radiochemotherapy, the values of Young′s modulus of the lesions increased with the increase of pT stage. Compared with the mean values of Young′s modulus of the lesions in pT3 stage, the differences of the mean values of Young′s modulus of the lesions in pT0, pT1 and pT2 stages were statistically significant(all P<0.01). Compared with the maximum values of Young′s modulus of the lesions in pT3 stage, the differences of the maximum values of Young′s modulus of the lesions in pT0 and pT1 stage were statistically significant(all P<0.01). The differences of the mean value and th

关 键 词：腔内超声检查 直肠肿瘤 弹性成像技术 剪切波弹性成像 新辅助放化疗 

分 类 号：R735[医药卫生—肿瘤] R44[医药卫生—临床医学]