DCE-MRI定量参数对骨肉瘤新辅助化疗反应的监测价值  

The Value of DCE-MRI Quantitative Parameters in Monitoring Neoadjuvant Chemotherapy Response of Osteosarcoma

作　　者：曾燕妮 张卜天[2] 宋亭[3] 郑倩 王娟婷[1] 袁强[1] 谭敏仪 ZENG Yanni;ZHANG Botian;SONG Ting(Department of Radiology,Huadu Distinct Peopled Hospital of Guangzhou,Guangzhou,Guangdong Province 510800,P.R.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,130033 [3]广州医科大学附属第三医院放射科,510150

出　　处：《临床放射学杂志》2019年第10期1924-1929,共6页Journal of Clinical Radiology

摘　　要：目的探讨DCE-MRI定量参数监测骨肉瘤新辅助化疗疗效反应的价值。方法回顾性分析经手术病理证实的骨肉瘤患者19例,全部患者均于实施新辅助化疗前和进行4个疗程化疗后行DCE-MRI检查,通过后处理软件计算定量参数:容积转运常数(Ktrans)、血管外细胞外空间的体积分数(Ve)、血浆体积分数(Vp)和组织间隙-血浆速率常数(Kep)。根据病理肿瘤坏死率Huvos分级法,分为反应良好组(肿瘤坏死率≥90%,n=10)和无反应组(肿瘤坏死率<90%,n=9)。采用Mann-Whitney U检验分析有反应组和无反应组的DCE-MRI定量参数和新辅助化疗前后参数的变化,采用ROC评估各参数化疗前后鉴别有反应组和无反应组的效能。结果 19例骨肉瘤患者接受新辅助化疗前后Ktrans和Kep两数值之间差异具有统计学意义(P<0.05),且Ktrans和Kep参数化疗前后差值分别为0.38±0.88、0.34±0.42,Kep值较Ktrans下降更显著;Ve和Vp两者化疗前后差值无统计学差异。进行新辅助化疗前,有反应组的DCE-MRI定量参数Ktrans、 Kep、 Ve、Vp分别为(0.53±0.57)/min、(0.74±0.36)/min、0.47±0.29、0.18±0.17;无反应组分别为(0.61±1.07)/min、(0.23±0.15)/min、0.45±0.33、0.25±0.27,两组之间t检验差异均无统计学意义(P>0.05)。进行新辅助化疗后,有反应组的DCE-MRI定量参数Ktrans、 Kep、 Ve、Vp分别为(0.06±0.04)/min、(0.72±0.32)/min、0.20±0.10、0.08±0.13;无反应组分别为(0.34±0.50)/min、(0.58±0.19)/min、0.35±0.22、0.20±0.25,两组之间化疗后Ktrans、 Kep参数有统计学差异,P值均<0.05,而Ve、Vp参数无统计学意义。新辅助化疗后,Ktrans、 Kep提示化疗反应不良(TNF<90%)的ROC曲线下面积分别为0.911、0.944,特异性和敏感性分别为90.0%和77.8%、90.0%和100.0%。联合Ktrans和Kep两参数反应化疗后TNF<90%的ROC曲线下面积为0.989,特异性和敏感性分别为90.0%和100.0%,可达更高诊断效能。结论 DCE-MRI定量参数可以反映骨肉瘤新辅助化�Objective To explore the value of DCE-MRI quantitative parameters in monitoring the efficacy of neoadjuvant chemotherapy for osteosarcoma. Methods 19 patients were confirmed osteosarcoma by pathology in this retrospective study. All patients underwent DCE-MRI exam before and after 4 courses of neoadjuvant chemotherapy. Quantitative parameters are calculated by post-processing software: Volume transfer constant(Ktrans),volume fraction(Ve),fractional volume of plasma(Vp),interstitial tissue-plasma rate constant(Kep).According to the Huvos’ tumor necrosis grading,divided into good response group(tumor necrosis rate≥ 90%,n=10) and non-response group(tumor necrosis rate < 90%,n=9).Mann-whitney U test was used to compare DCE-MRI quantitative parameters before and after neoadjuvant chemotherapy in the good response group and non-response group. ROC was used to evaluate the efficacy of quantitative parameter before and after chemotherapy in differentiating the good response group and non-response group. Results Ktrans and Kep was significant in 19 patients before and after neoadjuvant chemotherapy(P<0.05) and the difference before and after chemotherapy of Ktrans and Kep parameter was 0.38±0.88、0.34±0.42,respectively.Ktrans declined more than and Kep.There was no statistically significant difference between Ve and Vp before and after chemotherapy.Before neoadjuvant chemotherapy,Ktrans、 Kep、Ve、Vp of good response group was(0.53±0.57)/min、(0.74±0.36)/min、0.47±0.29、0.18±0.17,respectively.Non-response group is(0.61±1.07)/min、(0.23±0.15)/min、0.45±0.33、0.25±0.27.T test between the two groups was not statistically significant(P>0.05).After neoadjuvant chemotherapy,Ktrans、 Kep、 Ve、Vp of good response group was(0.06±0.04)/min、(0.72±0.32)/min、0.20±0.10、0.08±0.13 respectively,Non-response group is(0.34±0.50)/min、(0.58±0.19)/min、0.35±0.22、0.20±0.25.There were statistically significant differences in Ktransand Kep parameters between the two groups after chemotherapy.P values

关 键 词：DCE-MRI定量参数 骨肉瘤 新辅助化疗 

分 类 号：R73[医药卫生—肿瘤]