DCE-MRI半定量参数评估骨肉瘤新辅助化疗疗效的临床价值  

The clinical value of DCE-MRI Semi-quantitative parameters in monitoring neoadjuvant chemotherapy response of osteosarcoma

作　　者：曾燕妮 张卜天[2] 王娟婷[1] 袁强[1] 谭敏仪 严宗伟[1] Zeng Yanni;Zhang Botian;Wang Juanting;Yuan Qiang;Tan Minyi;Yan Zongwei(Department of Radiology,Huadu Distinct People's Hospital of Guangzhou,Guangzhou 510800,China;Department of Imaging,China-Japan Union Hospital of Jilin University,Changchun 130033,China)

机构地区：[1]广州市花都区人民医院放射科,510800 [2]吉林大学中日联谊医院影像科,长春130033

出　　处：《中国医师杂志》2019年第11期1653-1657,1662,共6页Journal of Chinese Physician

基　　金：2018年花都区医疗卫生一般科研专项项目(18-HDWS-024)~~

摘　　要：目的探讨动态增强磁共振(DCE-MRI)半定量参数对骨肉瘤新辅助化疗疗效的预测评估价值。方法回顾性分析经手术病理证实的骨肉瘤患者25例,于实施新辅助化疗(NAC)前及4个周期化疗后行DCE-MRI检查,通过后处理软件计算以下半定量参数:早期动态增强斜率值(Slope)、强化峰值(SImax)、达峰时间(TTP)、信号增强幅度(SEE)、增强峰值百分数(PPE)、廓清率(WOR)、强化率(R);根据肿瘤坏死率Huvos分级法,分为反应良好组(肿瘤坏死率≥90%,n=12)和无反应组(肿瘤坏死率<90%,n=13)。采用Mann-Whitney U检验两两比较NAC前后两组组内及组间的DCE-MRI半定量参数变化,ROC曲线评估各参数NAC前后鉴别反应良好组和无反应组的效能。结果反应良好组Slope、SImax、SEE、PPE、R、TTP、WOR等参数NAC前后差异均有统计学意义(P<0.05);无反应组NAC前后SImax、SEE差异有统计学意义(P<0.05);NAC前两组间TTP、R比较差异有统计学意义(P<0.05);NAC后两组间Slope、SImax、TTP、SEE、WOR、R等参数差异均有统计学意义(P<0.05)。采用ROC曲线预测各参数对骨肉瘤NAC后肿瘤坏死率的诊断效能,发现Slope、TTP、R三个参数预测骨肉瘤化疗后反应良好的灵敏度和特异度分别为83.3%和92.3%、91.7%和69.2%、84.6%和75.0%,曲线下面积(AUC)分别为0.872(95%CI:0.716~1.027)、0.846(95%CI:0.685~1.007)、0.833(95%CI:0.662~1.004),最佳界值分别为0.032%/s、175 s、5.441%,尤登指数分别为0.756、0.609、0.596。结论DCE-MRI半定量参数Slope、TTP、R对骨肉瘤新辅助化疗疗效具有较高的预测价值。Objective To evaluate the response of neoadjuvant chemotherapy on osteosarcoma by semi-quantitative parameters of dynamic contrast-enhancement magnetic resonance imaging( DCE-MRI).Methods Retrospectively analysis 25 cases of osteosarcoma confirmed by pathology. All cases received DCE-MRI scan before and after 4 cycles of neoadjuvant chemotherapy. The following semi-quantitative parameters were calculated by post-processing software: early dynamic enhancement wash-in slope( Slope),maximum signal intensity( SImax),time to peak( TTP),signal enhanced extent( SEE),peak percent enhancement( PPE),wash out rate( WOR),enhancement rate( R). All cases were divided into good response group( tumor necrosis rate ≥90%,n = 12) and non-response group( tumor necrosis rate < 90%,n = 13) according to the Huvos grading method. Semi-quantitative parameters of DCE-MRI before and after neoadjuvant chemotherapy between good response group and non-response group were compared by Mannwhitney U test. Receiver operating characteristic curve( ROC) analysis was performed to evaluate the efficacy of different good response group and non-response group after neoadjuvant chemotherapy( NAC). Results Slope,SImax,TTP,SEE,PPE,WOR,R,TTP,WOR before and after NAC in good response group were significant different( P < 0. 05),but only SImax,SEE in non-response group. TTP,R were significant different between the above two groups before NAC,and Slope,SImax,TTP,SEE,WOR,R were significant different after NAC( P < 0. 05). ROC was used to predict the diagnostic efficiency of various parameters for tumor necrosis rate after osteosarcoma NAC. It was found that the sensitivity and specificity of Slope,TTP and R parameters for predicting the response of osteosarcoma after chemotherapy were 83. 3%and 92. 3%,91. 7% and 69. 2%,84. 6% and 75. 0% respectively. The area under the curve( AUC)were 0. 872( 95% CI: 0. 716 to 1. 027),0. 846( 95% CI: 0. 685 to 1. 007),0. 833( 95% CI: 0. 662 to1. 004),the cut-off value were 0. 032,175 s,5. 441,Youden index were 0. 756,0. 609,

关 键 词：骨肉瘤 新生血管化 病理性 磁共振成像 磁共振血管造影术 

分 类 号：R73[医药卫生—肿瘤]