^(18)F-FDG PET/MR在评估局部进展期直肠癌新辅助放化疗效果中的价值  

Value of^(18)F-FDG PET/MR in evaluating the effect of neoadjuvant chemoradiotherapy in locally advanced rectal cancer

作　　者：周建立 杜磊[1] 刘家金[1] 胡时栋[3] 关志伟[1] 徐白萱[1] 田嘉禾[1] Zhou Jianli;Du Lei;Liu Jiajin;Hu Shidong;Guan Zhiwei;Xu Baixuan;Tian Jiahe(Department of Nuclear Medicine,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Department of Nuclear Medicine,Dezhou People′s Hospital,Dezhou 253000,China;Department of General Surgery,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]解放军总医院第一医学中心核医学科,北京100853 [2]德州市人民医院核医学科,253000 [3]解放军总医院第一医学中心普外科,北京100853

出　　处：《中华核医学与分子影像杂志》2021年第7期388-393,共6页Chinese Journal of Nuclear Medicine and Molecular Imaging

摘　　要：目的:评估局部进展期直肠癌患者新辅助放化疗(NCRT)前后^(18)F-脱氧葡萄糖(FDG)PET/MR参数及其变化在预测及评价疗效中的价值。 方法:回顾性分析2017年6月至2020年6月期间在解放军总医院第一医学中心病理学确诊并行NCRT的局部进展期直肠癌患者13例[男9例、女4例,年龄(52.2±13.2)岁]。所有患者于NCRT前1个月内行第1次PET/MR检查,并于术前1个月内行第2次PET/MR检查。收集患者治疗前后PET/MR代谢参数,包括最大标准摄取值(SUV_(max))、平均标准摄取值(SUV_(mean))、肿瘤代谢体积(MTV) 2.5、病灶糖酵解总量(TLG)、最小表观弥散系数(ADC_(min))以及治疗前后各参数百分比变化值(Δ);以术后病理结果作为评估疗效的"金标准"将患者分组:(1)分为病理完全缓解(pCR)组与非pCR组;(2)分为治疗有效组和无效组。采用Mann-Whitney U检验和单因素logistic回归分析数据,通过受试者工作特征(ROC)曲线确定有关参数的阈值和诊断效能。 结果:13例患者中,5例达到pCR,8例治疗有效。治疗前各检查参数在不同分组间均未见差异( U值:8.00~19.00,均 P>0.05);pCR组与非pCR组治疗后SUV_(max)、SUV_(mean)、MTV2.5、TLG和ΔADC min差异有统计学意义( U值:0.00~6.00,均 P<0.05),但仅治疗后SUV_(max)与pCR有关[比值比( OR)=0.335,95% CI:0.123~0.917, P=0.033],ROC曲线下面积(AUC)为0.95,SUV_(max)阈值为3.055时,灵敏度为100%,特异性为80.0%,准确性为92.3%;治疗有效和无效组治疗后SUV_(max)、SUV_(mean)、TLG、ADC_(min)以及ΔSUV_(max)、ΔADC_(min)差异有统计学意义( U值:0.00~6.00,均 P<0.05),但仅ΔSUV max与治疗效果有关( OR=2.022,95% CI:1.100~4.130, P=0.048),AUC为0.90,ΔSUV_(max)阈值为69.0%时,灵敏度为87.5%,特异性为80.0%,准确性为84.6%。结论:PET/MR在评估局部进展期直肠癌NCRT疗效方面具有较高的准确性,治疗后SUV_(max)是pCR发生的独立预测因子,而ΔSUV max是有组织学反应(治疗有效)的独立预测因子。Objective To assess the value of^(18)F-fluorodeoxyglucose(FDG)PET/MR parameters and their changes in predicting and evaluating the curative effect in patients with locally advanced rectal cancer before and after neoadjuvant chemoradiotherapy(NCRT).Methods From June 2017 to June 2020,13 patients(9 males,4 females;age(52.2±13.2)years)with locally advanced rectal cancer confirmed pathologically and underwent NCRT in Chinese PLA General Hospital were retrospectively enrolled.All patients performed the first PET/MR within one month before NCRT and the second PET/MR within one month before operation.PET/MR parameters including maximum standardized uptake value(SUVmax),mean standardized uptake value(SUVmean),metabolic tumor volume(MTV)2.5,total lesion glycolysis(TLG),minimum apparent diffusion coefficient(ADCmin),and their changing percentage(Δ)before and after NCRT were collected.Patients were divided into pathologically complete remission(pCR)group and non-pCR group or response group and non-response group according to the postoperative pathological results as the gold standard.Mann-Whitney U test and logistic regression analysis were used for data analysis.The cut-off values of related parameters and their diagnostic efficiencies were determined by receiver operating characteristic(ROC)curve analysis.Results Of 13 patients,5 reached pCR and 8 had histological reaction(response).There were no significant differences in parameters(SUVmax,SUVmean,MTV2.5,TLG,ADCmin)between different groups before treatment(U values:8.00-19.00,all P>0.05).There were significant differences in SUVmax,SUVmean,MTV2.5,TLG andΔADCmin between pCR group and non-pCR group after treatment(U values:0.00-6.00,all P<0.05),but only SUVmax was correlated with pCR after treatment(odds ratio(OR)=0.335,95%CI:0.123-0.917,P=0.033).The area under curve(AUC)was 0.95 and the cut-off value of SUVmax was 3.055,with the sensitivity of 100%,the specificity of 80.0%and the accuracy of 92.3%.There were significant differences in SUVmax,SUVmean,TLG,ADCmin,ΔSUVmax

关 键 词：直肠肿瘤 肿瘤辅助疗法 正电子发射断层显像术 磁共振成像 脱氧葡萄糖 治疗结果 

分 类 号：R735.37[医药卫生—肿瘤] R730.44[医药卫生—临床医学] R445.2