3.0T MRI扩散加权成像评估鼻咽癌放化疗近期及远期疗效的价值  

Value of 3.0T MRI Diffusion-Weighted Imaging in Evaluating Short-Term and Long-Term Efficacy of Chemo-Radiotherapy for Nasopharyngeal Carcinoma

作　　者：陈业媛[1] 郑威 邓峰[1] 徐莹[1] CHEN Ye-yuan;ZHEN Wei;DENG Feng;XU Ying(Department of Radiology,the First Affiliated Hospital of Nanchang University;Department of Radiology,Jiangxi Children’s Hospital,Nanchang 330006,China)

机构地区：[1]南昌大学第一附属医院放射科 [2]江西省儿童医院放射科,南昌330006

出　　处：《实用临床医学（江西）》2023年第4期52-56,F0004,共6页Practical Clinical Medicine

基　　金：江西省卫生计生委普通科技计划(20175125)。

摘　　要：目的研究MRI扩散加权成像对评估鼻咽癌放化疗近期及远期疗效的价值。方法收集2017年9月至2018年9月经病理证实为鼻咽癌并在南昌大学第一附属医院进行放化疗的初治患者,患者治疗前、治疗完成后3个月行MRI检查,并进行3年追踪随访,共入组40例病例。测量治疗前原发灶及最大转移淋巴结的最高ADC值、最低ADC值、平均ADC值、ADC差值。近期疗效根据实体肿瘤疗效评价标准(RESIET1.1)进行评估,分为完全缓解组(CR组)和非完全缓解组(NCR组)。远期疗效根据3年随访结果分为稳定组和复发转移组。对近期及远期疗效不同组间的ADC值进行比较,再进行受试者工作特性曲线(ROC)分析,找出预测疗效的最佳ADC值阈值及预测效能。结果40例鼻咽癌患者中CR组31例,NCR组9例;3年随访稳定组34例,复发转移组6例。近期疗效CR组治疗前原发灶的平均ADC值、最高ADC值、ADC差值均低于NCR组,且差异有统计学意义(P<0.05)。远期疗效稳定组中治疗前最大淋巴结转移灶的最高ADC值、ADC差值均低于复发转移组,且差异有统计学意义(P<0.05)。治疗前原发灶ADC差值(最佳阈值=0.613×10^(-3)mm^(2)·s^(-1))是预测近期疗效的最佳ADC值,预测NCR的敏感性、特异性分别为77.8%、83.9%,ROC曲线下面积为0.783。治疗前最大转移淋巴结的ADC差值(最佳阈值=1.021×10^(-3)mm^(2)·s^(-1))是预测远期疗效的最佳ADC值,预测复发转移的敏感性、特异性分别为66.7%、70.6%,ROC曲线下面积为0.681。结论测量鼻咽癌原发灶及最大转移淋巴结的ADC差值,具有预测鼻咽癌放化疗近期及远期疗效的潜在价值,有助于指导临床个体化治疗。Objective To investigate the value of diffusion-weighted MRI in evaluating the short-term and long-term efficacy of chemo-radiotherapy for nasopharyngeal carcinoma(NPC).Methods The newly treated patients with pathologically confirmed NPC who received chemo-radiotherapy in the First Affiliated Hospital of Nanchang University from September 2017 to September 2018 were selected in this study.Before and 3 months after treatment,all the patients underwent MRI and were followed up for 3 years.A total of 40 patients were enrolled.The highest,lowest and average apparent diffusion coefficient(ADC)values and the ADC difference of the primary lesion and the largest metastatic lymph node were measured before treatment.The short-term efficacy was evaluated according to the Response Evaluation Criteria in Solid Tumors(RECIST 1.1),and the patients were divided into complete remission group(CR group)and non-complete remission group(NCR group).In addition,the patients were divided into stable group and recurrent/metastatic group according to the 3-year long-term follow-up outcomes.The ADC values of groups with different short-term and long-term efficacy were compared,and then the receiver operator characteristic(ROC)curves were analyzed to explore the optimal ADC threshold and predictive efficacy.Results Among the 40 patients with NPC,31 had CR and 9 had NCR.After 3 years of follow-up,34 patients remained stable and 6 patients had recurrent or metastatic NPC.As for short-term efficacy,the average and highest ADC values and the ADC difference of the primary lesion in the CR group were lower than those in the NCR group before treatment(P<0.05).In terms of long-term efficacy,the highest ADC value and the ADC difference of the largest metastatic lymph node in the stable group were lower than those in the recurrent/metastatic group before treatment(P<0.05).The ADC difference of the primary lesion before treatment(optimal threshold=0.613×10^(-3)mm^(2)·s^(-1))was the optimal ADC to predict the short-term efficacy,with the sensitivity,

关 键 词：鼻咽癌 扩散加权成像 表观扩散系数 预测 疗效 

分 类 号：R739.63[医药卫生—肿瘤]