磁共振弥散加权成像表观弥散系数值预测局部晚期宫颈癌腔内后装放射治疗疗效的研究  

Clinical value of DWI-ADC value in predicting the curative effect of intracavitary brachytherapy on LACC

作　　者：李健 孔德军 胡祥 肖科 李虹成 涂波 刘冬梅 LI Jian;KONG De-jun;HU Xiang(Department of Radiology,The 2nd Affiliated Hospital of Chengdu Medical College,Nuclear Industry 416 Hospital,Chengdu 610051,China;不详)

机构地区：[1]成都医学院第二附属医院·核工业四一六医院放射科,四川成都610051 [2]成都医学院第二附属医院·核工业四一六医院肿瘤科,四川成都610051

出　　处：《中国医学装备》2023年第1期42-46,共5页China Medical Equipment

基　　金：四川省卫生和计划生育委员会科研课题(17PJ600)“磁共振弥散加权成像应用于局部晚期宫颈癌腔内后装放疗疗效预测、评价及成都医学院第二附属医院·核工业四一六医院盆腔随访的前瞻性临床研究”。

摘　　要：目的:研究磁共振弥散加权成像表观弥散系数(DWI-ADC)值在预测局部晚期宫颈癌(LACC)腔内后装放射治疗中的临床价值。方法:选取医院住院行腔内后装放射治疗的72例患者,依据腔内后装放射治疗疗效将其分为有效组(32例)和无效组(40例)。所有患者均按2次/周、5.75 Gy/周的频率开展腔内后装放射治疗,记录治疗相关不良反应,比较两组患者放射治疗前、放射治疗2次后的ADC值及ADC值差值,绘制受试者工作特征(ROC)曲线,分析ADC值预测LACC腔内后装放射治疗疗效的临床价值。结果:两组72例患者均顺利完成同步放化疗,治疗期间36例患者白细胞和(或)中性粒细胞减少,5例患者粒细胞减少性发热,25例患者贫血,5例患者血小板减少,2例患者出现呕吐、腹泻、腹痛等消化系统症状,其相关不良反应均为1~2级;有效组放射治疗前ADC值显著低于无效组,差异有统计学意义(t=-2.958,P<0.05),放射治疗2次后ADC值、ADC差值显著高于无效组,差异有统计学意义(t=5.390,t=5.738;P<0.05);ADC差值预测LACC腔内后装放射治疗疗效的ROC曲线下面积(AUC)最高,以0.46为ADC差值临界值(cut-off),其预测LACC腔内后装放射治疗疗效的灵敏度、特异度分别为75.00%和78.12%。结论:ADC值可作为LACC腔内后装放射治疗疗效的可靠指标,其中放射治疗前及放射治疗2次后的ADC差值预测效能更显著。Objective: To analyze the clinical value of diffusion-weighted imaging-apparent diffusion coefficient(DWIADC) value in predicting the curative effect of intracavitary brachytherapy on locally advanced cervical cancer(LACC).Methods: Seventy-two patients who underwent intracavitary brachytherapy in hospital were selected and were divided into the effective group(32 cases) and the ineffective group(40 cases) according to the curative effect of intracavitary brachytherapy. All patients underwent intracavitary brachytherapy as the frequency of twice/week and 5.75 Gy/week so as to record relevant adverse reaction. The ADC value and the difference value of ADC value before and after 2 times of radiotherapy between two groups were compared. The receiver operating characteristics(ROC) curve was drawn to analyze the clinical value of ADC value in predicting the curative effect of intracavitary brachytherapy on LACC.Results: All of 72 patients successfully completed concurrent radiochemotherapy, the ratio of white cell to neutrophil of 36 patients reduced during treatment period, and 5 patients occurred granulopenia fever, and 25 patients were anemia, and 5 patients occurred thrombocytopenia, and 2 patients occurred gastrointestinal symptom included emesis,diarrhea and bellyache, and the relevant adverse reaction of them were 1-2 grades. Before treatment, the ADC value of effective group was significantly lower than that of ineffective group(t=-2.958, P<0.05), and the ADC value and the difference value of ADC value after 2 times of radiotherapy of effective group were significantly higher than those of ineffective group(t=5.390, t=5.738, P<0.05). The area under curve(AUC) of ROC curve of the ADC difference value was highest in predicting the curative effect of intracavitary brachytherapy on LACC. When the cut-off value of ADC difference value was 0.46, the sensitivity and specificity of that were respectively 75.00% and 78.12% in predicting the curative effect of intracavitary brachytherapy on LACC. Conclusion: The ADC valu

关 键 词：磁共振(MR) 局部晚期宫颈癌(LACC) 腔内后装放射治疗 疗效 弥散加权成像(DWI) 表观弥散系数(ADC) 

分 类 号：R737.33[医药卫生—肿瘤] R445.2[医药卫生—临床医学]