磁共振T2WI肿瘤相关信号指标预测局部进展期直肠癌新辅助放化疗后病理完全缓解的价值  

The value of MR T2WI signal intensity related parameters for predicting pathological complete response to neoadjuvant chemoradiotherapy in locally advanced rectal cancer

作　　者：万丽娟 张翀达 张红梅 孟闫凯 叶枫 刘媛 赵心明 周纯武 Wan Lijuan;Zhang Chongda;Zhang Hongmei;Meng Yankai;Ye Feng;Liu Yuan;Zhao Xinming;Zhou Chunwu(Department of Diagnostic Radiology,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)

机构地区：[1]国家癌症中心国家肿瘤临床医学研究中心中国医学科学院北京协和医学院肿瘤医院影像诊断科,100021

出　　处：《中华肿瘤杂志》2019年第11期837-843,共7页Chinese Journal of Oncology

基　　金：卫生公益性行业科研专项(201402019);北京市科技计划(Z161100000516101);中国癌症基金会北京希望马拉松专项基金(LC2016A05);国家重点研发计划(2016YFC0905303)。

摘　　要：目的评估磁共振(MR)图像中T2WI肿瘤相关信号指标预测局部进展期直肠癌新辅助放化疗后病理完全缓解(pCR)的应用价值.方法由2位临床经验丰富的诊断科医师分别独立测量101例局部进展期直肠癌患者新辅助放化疗前后的MR T2WI肿瘤绝对信号强度(SIT)、肿瘤相对信号强度(SIT/M),计算SIT减低率(SITRR)和SIT/M减低率(SIT/M RR),比较pCR组和非病理完全缓解(non-pCR)组T2WI肿瘤相关信号指标的差异.采用受试者工作特征(ROC)曲线分析评估各指标预测局部进展期直肠癌新辅助放化疗后pCR的效能.结果101例患者中,pCR组18例,non-pCR组83例.全部患者中,医师1测量的pCR组SITpre、SITpost、SITRR、SIT/Mpre、SIT/Mpost和SIT/MRR分别为197.0(133.0)、144.2(69.7)、0.4%(0.5%)、2.6(0.6)、3.0(2.3)和0.4(0.2)%,non-pCR组分别为227.0(99.0)、205(95.4)、0.1%(0.6%)、2.6(0.6)、2.6(1.5)和0.3%(0.2%);医师2测量的pCR组SITpre、SITpost、SITRR、SIT/Mpre、SIT/Mpost和SIT/MRR分别为193.0(135.0)、143.0(69.8)、0.4%(0.2%)、2.6(0.6)、1.5(0.5)和0.39%(0.2%),non-pCR组分别为234.0(108.0)、203(96.5)、0.1%(0.3%)、2.6(0.6)、1.7(0.7)和0.25%(0.2%).pCR组与non-pCR组比较,2位医师测量的SITpost、SⅡ/Mpost和SIT/MRR差异均有统计学意义(均P<0.01),SITpre和SIT/Mpre差异均无统计学意义(均P>0.05);第1位医师测量的SITRR差异无统计学意义(P=0.415),而第2位医师测量的SITRR差异有统计学意义(P=0.001).仅直肠非黏液腺癌患者中,2位医师测量的SITpost、SIT/Mpost、SITRR和SIT/MRR在pCR组与non-pCR组间差异仍然有统计学意义(均P<0.01),而SITpre和SIT/Mpre差异均无统计学意义(均P>0.05).ROC曲线分析显示,在全部患者,SITpost、SIT/Mpost和SIT/MRR预测局部进展期直肠癌新辅助放化疗后pCR的曲线下面积(AUC)为0.694~0.762,灵敏度为68.2%~77.3%,特异度为63.6%~77.3%.在直肠非黏液腺癌患者,AUC为0.704~0.764,灵敏度为62.7%~78.9%,特异度为66.2%~84.2%.结论MR T2WI肿瘤相关信号强度可�Objective To evaluate the value of T2WI signal intensity related parameters that can be obtained by magnetic resonance imaging(MRI)for predicting pathological complete response(pCR)after neoadjuvant chemoradiotherapy(nCRT)in patients with locally advanved rectal cancer(LARC).Methods Signal Intensity of Tumor(SIT)and Signal Intensity of Tumor/Muscle(SIT/M)of MR T2WI before and after neoadjuvant chemoradiotherapy of 101 patients with locally advanced rectal cancer were evaluated by two experienced readers independently.Signal Intensity of Tumor Reduction Rate(SITRR)and Signal Intensity of Tumor/Muscle Reduction Rate(SIT/MRR)were calculated.The difference of related parameters of T2WI tumor signal intensity between the pCR and the non-pCR group were analyzed.Receiver operating characteristic(ROC)analysis was used to assess the diagnostic performance for predicting pCR.Results Of the 101 patients,18 were in pCR group and 83 were in non-pCR group.In all patients,the SITpre,SITpost,SITRR,SIT/Mpre,SIT/Mpost and SIT/MRR measured by reader 1 were 197.0(133.0),144.2(69.7),0.4%(0.5%),2.6(0.6),3.0(2.3)and 0.4(0.2)%in pCR group,and 227.0(99.0),205(95.4),0.1%(0.6%),2.6(0.6),2.6(1)in non-pCR group,respectively.SITpre,SITpost,SITRR,SIT/Mpre,SIT/Mpost and SIT/MRR measured by reader 2 were 193.0(135.0),143.0(69.8),0.4%(0.2%),2.6(0.6),1.5(0.5)and 0.39%(0.2%)in pCR group,and 234.0(108.0),203(96.5),0.1%(0.3%),2.6(0.6%),1.7(0.7)and 0.25%(0.2%)in non-pCR group,respectively.Between the pCR and non-pCR group,there were significant differences in SITpost,SIT/Mpost and SIT/MRR measured by both readers(all P<0.01),but there was no significant differences in SITpre and SIT/Mpre(P>0.05).The difference of SITRR measured by reader 1 was not statistically significant(P=0.415),while the difference of SITRR measured by reader 2 was statistically significant(P=0.001).In patients with rectal non-mucinous adenocarcinoma,SITpost,SIT/Mpost,SITRR and SIT/MRR measured by two physicians were still statistically significant between the pCR and non-pCR grou

关 键 词：直肠肿瘤 核磁共振 T2WI信号强度 新辅助放化疗 病理完全缓解 

分 类 号：R73[医药卫生—肿瘤]