弥散加权成像联合动态对比增强MRI对直肠癌治疗反应的预测价值  

Predictive value of diffusion-weighted imaging combined with dynamic contrast-enhanced MRI in treatment response of rectal cancer

作　　者：韦明炯[1] 刘雨峰[1] 张林凤 杜苗娜 赵宇新[2] WEI Mingjiong;LIU Yufeng;ZHANG Linfeng;DU Miaona;ZHAO Yuxin(Imaging Department, Shanxi Province Second People's Hospital, Xi'an 710005, China;Radiology Department, Xi'an North Hospital, Xi'an 710068, China)

机构地区：[1]陕西省第二人民医院影像科,陕西西安710005 [2]西安市北方医院放射科,陕西西安710068

出　　处：《西部医学》2020年第11期1697-1701,共5页Medical Journal of West China

摘　　要：目的研究弥散加权成像(DWI)联合动态对比增强MRI对直肠癌术前新辅助放化疗治疗反应的预测价值。方法选取2016年1月~2019年1月陕西省第二人民医院收治的直肠癌患者76例,所有患者均行弥散加权成像(DWI)与动态对比增强MRI扫描和新辅助放化疗治疗,在化疗结束后行手术干预治疗。以患者手术后病理检测分级为金标准,根据手术病理检测分为治疗反应组和治疗无反应组,分析患者肿瘤退缩率、ADC值、定量血流动力学参数变化。结果76例直肠癌患者新辅助放化疗前肿瘤最大直经为(5.02±0.58)cm,新辅助放化疗后肿瘤最大直径为(3.00±0.35)cm;在新辅助放化疗结束7 d后76例患者均行手术切除治疗,行手术病理分级Ⅰ级~Ⅲ级53例为治疗反应组,Ⅳ~Ⅴ级23例为治疗无反应组。治疗反应组患者肿瘤退缩率、ADC值均高于治疗无反应组,定量血流动力学参数ktrans、Kep、Ve均低于治疗无反应组(P<0.05)。弥散加权成像联合动态对比增强MRI与直肠癌治疗反应的Logistic回归分析结果显示,ADC值、ktrans、Kep、Ve与直肠癌治疗反应相关(P<0.05)。结论弥散加权成像联合动态对比增强MRI中肿瘤退缩率、ADC值、定量血流动力学参数变化,可有效预测直肠癌患者新辅助放化疗的治疗反应。Objective To study the predictive value of diffusion-weighted imaging(DWI) combined with dynamic contrast-enhanced MRI in response to neoadjuvant chemotherapy for rectal cancer before operation.Methods 76 patients with rectal cancer admitted to our hospital from January 2016 to January 2019 were selected. All patients underwent diffusion-weighted imaging(DWI) and dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI) and neoadjuvant radiotherapy and chemotherapy. After the end of chemotherapy, surgical intervention was performed. According to the pathological examination, the patients were divided into treatment response group and treatment non-response group. Postoperative pathological examination was graded as gold standard, and the changes of tumor regression rate, ADC value and quantitative hemodynamic parameters were analyzed.Results Before neoadjuvant radiotherapy and chemotherapy, the maximum diameter of tumor was(5.02±0.58) cm and the maximum diameter was(3.00±0.35) cm in 76 patients with rectal cancer. Seven days after neoadjuvant radiotherapy and chemotherapy, 76 patients were operated and resected, 53 patients were operated and pathological grade Ⅰ-Ⅲ as the treatment response group, 23 patients were treated and non response group. The tumor regression rate and ADC value of patients in the treatment response group were higher than those in the treatment non response group, and the quantitative hemodynamic parameters Ktrans, Kep and Ve were lower than those in the treatment non response group(P<0.05). The results of logistic regression analysis showed that ADC, Ktrans, Kep and Ve were correlated with the response of rectal cancer(P<0.05).Conclusion Diffusion-weighted imaging combined with dynamic contrast-enhanced MRI can effectively predict the response of patients with rectal cancer to neoadjuvant radiotherapy and chemotherapy before operation.

关 键 词：弥散加权成像 动态对比增强MRI 直肠癌 治疗反应 

分 类 号：R735.37[医药卫生—肿瘤] R445.2[医药卫生—临床医学]