功能MRI联合临床预后因素预测同步放化疗治疗宫颈鳞癌疗效  

Functional MRI combined with clinical prognostic factors for predicting response to concurrent chemoradiotherapy for cervical squamous cell carcinoma

作　　者：杨蔚 杨妍 何剑莉 田海萍[4] 丁伟伟 冯少彤 YANG Wei;YANG Yan;HE Jianli;TIAN Haiping;DING Weiwei;FENG Shaotong(Department of Radiology,Tumor Hospital of General Hospital of Ningxia Medical University,Yinchuan 750004,China;Department of Information,the 942nd Hospital of Chinese People's Liberation Army,Yinchuan 750004,China;Department of Radiotherapy,Tumor Hospital of General Hospital of Ningxia Medical University,Yinchuan 750004,China;Department of Pathology,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏医科大学总医院肿瘤医院放射科,宁夏银川750004 [2]中国人民解放军联勤保障部队第九四二医院信息科,宁夏银川750004 [3]宁夏医科大学总医院肿瘤医院放疗科,宁夏银川750004 [4]宁夏医科大学总医院病理科,宁夏银川750004

出　　处：《中国医学影像技术》2020年第3期433-438,共6页Chinese Journal of Medical Imaging Technology

基　　金：国家自然科学基金(81860302);宁夏自然科学基金(2018AAC03158);宁夏医科大学重点项目(XZ2018006)。

摘　　要：目的探讨功能MRI联合临床预后因素(CPF)预测同步放化疗(CCRT)对于宫颈鳞癌疗效的诊断效能。方法对59例宫颈鳞癌接受CCRT患者于治疗前及治疗后3个月行DWI和动态对比增强MRI(DCE-MRI)。根据治疗后MRI及临床检查结果,将其分为肿瘤残余组(n=19)和无肿瘤残余组(n=40),比较2组间MRI和CPF差异,绘制MRI参数的ROC曲线,并计算其AUC,评估其诊断效能;分析宫颈鳞癌CCRT预后因素。结果肿瘤残余组治疗前肿瘤低强化区最大上升斜率(MSI L)和信号强化率(SER L)低于无肿瘤残余组(P均<0.01),而ADC和CPF中患者FIGO分期及淋巴结转移例数均高于无肿瘤残余组(P均<0.05)。MSI L联合ADC值预测CCRT后肿瘤残余的诊断效能高于单一MRI参数;MRI多参数联合CPF可提高其诊断效能。治疗前MSI L和ADC值是宫颈鳞癌治疗后肿瘤残余的独立预后因素。结论治疗前MSI L和ADC值是宫颈鳞癌CCRT治疗后肿瘤残余的独立预后因素。MRI多参数联合CPF可提高预测宫颈鳞癌CCRT疗效的诊断效能。Objective To explore functional MRI combined with clinical prognostic factors(CPF)for predicting response to concurrent chemoradiotherapy(CCRT)in patients with cervical squamous cell carcinoma.Methods Totally 59 patients with cervical squamous cell carcinoma who received CCRT were collected.All patients underwent diffusion weighted imaging(DMI)and dynamic contrast-enhanced MRI before and 3 months after CCRT.Then the patients were divided into non-tumor residual group(n=19)and tumor residual group(n=40)according to the results of MRI and clinical examination 3 months after CCRT,and MRI results and clinical prognostic factors(CPF)were compared between 2 groups.ROC curve of MRI parameters were drawn,AUC was calculated to evaluate the diagnostic efficacy,and the prognostic factor of CCRT for cervical squamous cell carcinoma was analyzed.Results Pre-treatment maximum slope of increase(MSI L)and signal enhancement ratio(SER L)of tumor low enhancement area in tumor residual group were lower than those in non-tumor residual group(all P<0.01),while pre-treatment ADC value and the number of patients with FIGO staging and lymph node metastasis in CPF were all higher than those in non-tumor residual group(all P<0.05).The diagnostic efficacy of MSI L combined with ADC value for predicting tumor residual after CCRT was higher than that of single MRI parameter.The diagnostic efficiency was improved MRI combining multi-parameter with CPF.Pre-treatment MSI L and ADC values were independent prognostic factors for tumor residue after CCRT for cervical squamous cell carcinoma.Conclusion Pre-treatment MSI L and ADC value were independent prognostic factors for tumor residue after CCRT for cervical squamous cell carcinoma.Multi-parameter MRI combined with CPF can improve diagnostic efficacy of predicting efficacy of CCRT for cervical squamous cell carcinoma.

关 键 词：宫颈肿瘤 治疗结果 磁共振成像 预后 

分 类 号：R711.74[医药卫生—妇产科学] R445.2[医药卫生—临床医学]