动态增强磁共振成像评价进展期食管癌同步放化疗的早期疗效  

Value of dynamic contrast-enhanced magnetic resonance imaging in predicting response to chemoradiotherapy for locally advanced esophageal cancer

作　　者：顾玲玲[1] 郭震 沈文荣 谢晓东[1] 钱普东[2] 江宁[2] GU Lingling;GUO Zhen;SHEN Wenrong;XIE Xiaodong;QIAN Pudong;JIANG Ning(Department of Radiology,The Affiliated Cancer Hospital of Nanjing Medical University,Jiangsu Cancer Hospital&Jiangsu Institute of Cancer Research,Nanjing 210009,China)

机构地区：[1]南京医科大学附属肿瘤医院江苏省肿瘤医院江苏省肿瘤防治研究所医学影像中心,南京210009 [2]江苏省肿瘤医院放疗科,210009

出　　处：《临床肿瘤学杂志》2022年第9期806-812,共7页Chinese Clinical Oncology

基　　金：南京医科大学附属肿瘤医院院内基金(ZM201812);南京医科大学影像菁英人才支持项目(320.1140.2022.0510.005)。

摘　　要：目的 探讨动态对比增强磁共振成像(DCE-MRI)在预测进展期食管癌同步放化疗(CRT)早期疗效中的潜在应用价值。方法 收集江苏省肿瘤医院2018年10月至2020年5月诊断为局部晚期食管癌患者33例,所有患者均接受CRT治疗。患者在CRT前(治疗前)和开始CRT后2~3周(治疗中)接受DCE-MRI检查。治疗3个月后将患者分为两组:完全缓解组(22例)和非完全缓解组(11例)。统计两组DCE-MRI定量参数,包括容量转移常数(K^(trans))、回流速率常数(K_(ep))、血管外细胞外容积分数(Ve)及以上参数变化(rΔK^(trans)、ΔK_(ep)、ΔV_(e))和比率(rΔK^(trans)、rΔK_(ep)和rΔV_(e)),并进行比较。采用受试者操作特征曲线(ROC)评估各参数评价疗效的效能。结果 完全缓解组在治疗中K^(trans)值、K_(ep)值分别为(0.29±0.13) min、(2.11±0.64) min,与治疗前的(0.42±0.13) min和(3.38±0.89) min比较明显下降,差异均有统计学意义(P<0.05);而在非完全缓解组,治疗中K_(ep)值为(1.91±0.83) min,与治疗前的(2.61±1.23) min比较明显下降,差异有统计学意义(P=0.047)。完全缓解组治疗前K值、K_(ep)值均高于非完全缓解组,差异有统计学意义(P=0.027,P=0.046);两组治疗中K^(trans)值、K_(ep)值进行比较,差异均无统计学意义(P>0.05)。ROC曲线结果显示,治疗前K^(trans)值可能是评估治疗效果的最佳参数(AUC=0.74),灵敏度和特异度分别为90.9%和54.5%。结论 治疗前K^(trans)值可能是预测局部晚期食管癌CRT疗效的较敏感的参数。Objective To investigate the potential application of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)in predicting the early curative result of concurrent chemoradiation(CRT)for locally advanced esophageal carcinoma.Methods A total of 33 patients with locally advanced esophageal cancer diagnosed and treated with CRT in Jiangsu Cancer Hospital from October 2018 to May 2020 were involved in this study.The patients underwent DCE-MRI before CRT(pre-CRT)and 2-3 weeks after starting CRT(mid-CRT).The patients were invided into two groups:22 in complete response(CR)and 11 in non-complete response(non-CR)after 3 months of treatment.The quantitative parameters of DCE-MRI(Ktrans,K_(ep)and Ve),the changes of parameters(ΔKtrans,ΔK_(ep)andΔVe)and ratios of parameters(rΔK^(trans),rΔK_(ep)and rΔVe)were calculated and compared between two timeframes in two groups.Moreover,the efficacy of each parameter in evaluating the curative result of CRT was evaluated by the receiver operating characteristic curve(ROC).Results In the CR group,the Ktransand K_(ep)value of mid-CRT were(0.29±0.13)min-1and(2.11±0.64)min-1respectively,which were significantly lower than(0.42±0.13)min-1and(3.38±0.89)min-1of preCRT,and the difference was statistically significant(P<0.05).In the non-CR group,the K_(ep)value of mid-CRT was(1.91±0.83)min-1,which was significantly lower than(2.61±1.23)min-1of pre-CRT,and the difference was statistically significant(P=0.047).The Ktransand K_(ep)value of pre-CRT in the CR group were higher than those in the non-CR group(P=0.027,P=0.046).There was no significant difference in the value of Ktransand K_(ep)between CR group and non-CR group(P>0.05).ROC curve results showed that Ktransvalue of pre-CRT may be the best parameter to evaluate the treatment effect(AUC=0.74),with sensitivity and specificity of 90.9%and 54.5%,respectively.Conclusion The value of Ktransbefore treatment could be a promising parameter to predict how patients with locally advanced esophageal cancer will respond to CRT.

关 键 词：食管癌 同步放化疗 动态对比增强磁共振成像(DCE-MRI) 

分 类 号：R735􀆰[医药卫生—肿瘤]