3.0 T磁共振弥散加权成像评估直肠癌新辅助放化疗临床价值  

Clinical Value of 3.0 T Magnetic Resonance Diffusion-weighted Imaging in Evaluating Neoadjuvant Chemoradiotherapy in Rectal Cancer

作　　者：周海燕[1] 钟亚鼎[2] 陆启芳[1] ZHOU Haiyan;ZHONG Yading;LU Qifang(School of Clinical Medicine,Anhui Medical College;the First Affiliated Hospital of Anhui Medical University,Hefei 230011 China)

机构地区：[1]安徽医学高等专科学校临床医学院 [2]安徽医科大学第一附属医院,安徽合肥230011

出　　处：《锦州医科大学学报》2024年第6期56-61,共6页Journal of Jinzhou Medical University

基　　金：2021年度高等学校省级质量工程项目,项目编号:2021zyyh026。

摘　　要：目的探讨3.0 T磁共振(magnetic resonance,MR)弥散加权成像(diffusion-weighted imaging,DWI)对局部进展期直肠癌(locally advanced rectal cancer,LARC)新辅助放化疗(neoadjuvant chemoradiotherapy,nCRT)疗效的预测价值。方法收集2022年1月至2023年12月于安徽医科大学第一附属医院收治的并采取nCRT治疗方案的60例LARC患者为样本。患者治疗前后均完成磁共振成像(magnetic resonance imaging,MRI)检查(常规扫描+DWI)。根据治疗前及术后病理分期将患者分为T-降期和T-非降期,比较两组nCRT前后表观扩散系数(apparent diffusion coefficient,ADC)值、ADC值变化量(ΔADC)及ADC值变化率(%)的差异,并采用受试者工作特征曲线(ROC)分析治疗前ADC值对nCRT的预测价值。结果60例患者T-降期35例(58.3%),其中12例(20.0%)获得病理完全反应(pathological complete response,pCR),T-非降期25例(41.7%)。患者nCRT治疗前ADC值为(0.84±0.19)×10^(-3)mm^(2)/s,治疗后ADC值为(1.25±0.22)×10^(-3)mm^(2)/s,差异有统计学意义(P<0.05)。T-降期组和T-非降期组nCRT前后ADC值比较差异均有统计学意义(P<0.05),治疗前T-降期组ADC值低于T-非降期组,治疗后T-降期组ADC值高于T-非降期组。与T-非降期组相比,T-降期组nCRT前后的ADC值变化量及ADC值变化率(%)均增高,差异有统计学意义(P<0.05)。pCR患者nCRT前ADC值低于T-降期组,nCRT后ADC值高于T-降期组,差异有统计学意义(P<0.05)。结论MR-DWI定量参数ADC在预测直肠癌nCRT的疗效中具有一定价值,治疗前低ADC值可提示更好的治疗反应性。Objective To investigate the predictive value of 3.0 T magnetic resonance(MR)diffusion-weighted imaging(DWI)on the efficacy of neoadjuvant chemoradiotherapy(nCRT)in locally advanced rectal cancer(LARC).Methods 60 LARC patients admitted to the First Affiliated Hospital of Anhui Medical University between January 2022 and December 2023 were collected as samples.Patients completed magnetic resonance imaging(MRI)(routine scan+DWI).Patients were divided into T-down and T-off stages according to the pre-treatment and postoperative pathological stage.The difference of apparent diffusion coefficient(ADC),ADC value(ΔADC)and ADC value rate(%)was compared between the two groups before and after nCRT,and the predictive value of pre-treatment ADC value on nCRT was analyzed by the receiver operating characteristic curve(ROC)for nCRT.Results Among 60 patients,there were 35 cases(58.3%)in the T downstaging group[including 12 cases(20.0%)of pCR]and 25 cases(41.7%)in the T non-downstaging group.The ADC value of patients before nCRT treatment was(0.84±0.19)×10^(-3)mm^(2)/s,and the ADC value after treatment was(1.25±0.22)×10^(-3)mm^(2)/s.The difference was statistically significant(P<0.05).There was a significant difference in the ADC value before and after nCRT in the T downstaging group and the T non-downstaging group(P<0.05).The ADC value of the T downstaging group before treatment was lower than that of the T non-downstaging group while the ADC value of the T downstaging group after treatment was higher than that of the T non-downstaging group.Compared with the T non-downstaging group,the ADC value change and ADC value change rate(%)before and after nCRT were increased in the T downstaging group(P<0.05).The ADC value of pCR patients before nCRT was lower than that of the T downstaging group while the ADC value after nCRT was higher than that of the T downstaging group(P<0.05).Conclusion MR-DWI quantitative parameter ADC has a certain value in predicting the nCRT efficacy of rectal cancer.A low ADC value before treatment may

关 键 词：新辅助治疗 磁共振成像 弥散加权成像 表观扩散系数 受试者工作特征曲线 

分 类 号：R445.2[医药卫生—影像医学与核医学]