多b值弥散加权磁共振成像在老年原发性中枢神经系统淋巴瘤患者预后评估中的应用价值  

Application value of multi-b-value diffusion-weighted magnetic resonance imaging in prognosis evaluation of elderly patients with primary central nervous system lymphoma

作　　者：吴昊 康惠 陈波斌 马燕 林之光 姚振威 Wu Hao;Kang Hui;Chen Bobin;Ma Yan;Lin Zhiguang;Yao Zhenwei(Department of Radiology,Huashan Hospital,Fudan University,Shanghai,200040,P.R.China;Department of Hematology,Huashan Hospital,Fudan University,Shanghai,200040,P.R.China)

机构地区：[1]复旦大学附属华山医院放射科,上海200040 [2]复旦大学附属华山医院血液科,上海200040

出　　处：《老年医学与保健》2022年第1期107-114,共8页Geriatrics & Health Care

摘　　要：目的探讨多b值弥散加权磁共振成像(multi-b-value diffusion-weighted magnetic resonance imaging,eDWI-MRI)参数及临床特征在老年原发性中枢神经系统淋巴瘤(primary central nervous system lymphoma,PCNSL)患者预后评估中的应用价值。方法收集2015年5月—2021年3月在复旦大学附属华山医院就诊的60岁及以上PCNSL患者的临床资料,所有患者均在治疗前后接受eDWI及常规MRI序列扫描。在T1WI增强与eDWI序列融合图像上进行强化灶勾画。在中位随访时间40个月之后,使用Kaplan-Meier法和Cox回归进行eDWI参数及临床资料的生存分析。结果共计32例患者纳入研究。中位无进展生存期(progression-free survival,PFS)及总生存期(overall survival,OS)分别为7个月和37个月。单因素分析显示,更短OS与以下因素相关:化疗前标准表观弥散系数(standard apparent diffusion coefficient,Standard ADC)、慢表观弥散系数(slow apparent diffusion coefficient,Slow ADC;ono)、分布弥散系数(distributed diffusion coefficient,DDC)及化疗后慢表观弥散系数(Slow ADC1;ono)<中位数,化疗后弥散异质性指数α值减小;年龄≥69.5岁、初始卡式活动状态评分(karnofsky performance score,KPS)<50分、脑脊液累及、多发病灶、2个疗程未达部分缓解(partial remission,PR)、4个疗程未达完全缓解(complete remission,CR)。多因素分析显示,更短PFS的独立预后相关因素是:4个疗程未达CR(P=0.003);更短OS的独立预后相关因素是:1个疗程后α值减小(P=0.027)、4个疗程未达CR(P=0.003)。结论 eDWI参数是老年PCNSL患者预后评估的良好影像学指标,在治疗初期筛选出预后不良高风险患者进行分层治疗,有助于延长PFS和OS,改善患者预后。Objective To study the application value of multi-b-value diffusion-weighted magnetic resonance imaging(DWI)parameters and clinical characteristics in the prognostic evaluation of elderly patients with primary central nervous system lymphoma(PCNSL).Methods The clinical data of PCNSL patients aged60 and over who were treated in Huashan Hospital Affiliated to Fudan University from May2015 to March2021 were collected.All patients underwent enhanced diffusion weighted imaging(eDWI)and conventional MRI sequence scans before and after treatment.The enhanced focus was outlined on the fusion image of T1 WI contrast-enhanced and eDWI sequence.After a median follow-up of40 months,survival analysis of eDWI parameters and clinical data was performed by Kaplan-Meier method and Cox regression.Results A total of32 patients were included in this study.The median progression free survival(PFS)and overall survival(OS)were7 months and37 months,respectively.Univariate analysis showed that shorter OS was associated with the following factors:standard apparent diffusion coefficient(standard ADC),slow apparent diffusion coefficient(slow ADC_Mono),distributed diffusion coefficient(DDC)before chemotherapy,slow ADC_Mono after chemotherapy,age M 69.5 years old,initial Kamofsky performance score(KPS)<50 points,cerebrospinal fluid involvement,multiple lesions,failure to achieve partial remission(PR)in 2 courses and complete remission(CR)in4 courses.Multivariate analy sis showed that independent prognostic factors for shorter PFS were:failure to achieve CR in four cycles(P=0.003);independent prognostic factors for shorter OS were:the a value decreased after one course of treatment(P=0.027)and failure to achieve CR after 4 courses of treatment(P=0.003).Conclusion eDWI parameters are good imaging indexes for prognostic evaluation of elderly PCNSL patients.Identification of high-risk patients with poor prognosis in the early stage of treatment for stratified treatment will help to prolong the PFS and OS and improve the prognosis of patients.

关 键 词：老年 原发性中枢神经系统淋巴瘤(PCNSL) 磁共振成像 弥散加权成像 表观弥散系数 预后因素 

分 类 号：R445.2[医药卫生—影像医学与核医学] R739.4[医药卫生—诊断学]