多种扩散加权成像模型预测局部进展期胃癌新辅助治疗疗效的价值  

Value of multiple diffusion weighted imaging models in predicting the efficacy of neoadjuvant-treated locally advanced gastric cancer

作　　者：后雅珺 桑梓桐 李琼 武鹏飞[1] 李博文 刘希胜[1] HOU Yajun;SANG Zitong;LI Qiong;WU Pengfei;LI Bowen;LIU Xisheng(Department of Radiology,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China;Department of General Surgery,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学第一附属医院放射科,江苏南京210029 [2]南京医科大学第一附属医院普外科,江苏南京210029

出　　处：《实用放射学杂志》2025年第3期419-423,共5页Journal of Practical Radiology

基　　金：国家自然科学基金项目(82071919)。

摘　　要：目的 探讨基于单指数模型(MEM)、扩散峰度成像(DKI)模型和拉伸指数模型(SEM)的扩散加权成像(DWI)定量参数预测局部进展期胃癌(LAGC)新辅助治疗疗效的价值.方法 前瞻性纳入40例在新辅助治疗前和根治性手术前均行 MRI检查的LAGC患者.由1名放射科医师在DWI图像上勾画病灶并获取治疗前后定量参数,包括病灶体积、MEM表观扩散系数(ADC)、DKI模型平均扩散速率(MD)和平均峰度(MK)、SEM体素内平均扩散速率(DDC)和体素内水分子扩散异质性系数(α).根据病理肿瘤退缩分级(TRG),将患者分为良好反应组(TRG 0~1级)和不良反应组(TRG 2~3级).利用 Mann-Whitney U检验比较治疗前参数、治疗前后参数变化值(Δ)在2组间的差异;采用二元logistic回归进行多因素分析.构建多种DWI模型及联合模型,并计算各模型预测效能.结果 新辅助治疗前各参数在2组间均无统计学差异(P>0.05).治疗前后体积变化值、ΔADC、ΔMD、ΔDDC在2组间均有统计学差异(P<0.05).ΔADC、ΔMD、ΔDDC预测LAGC良好反应的曲线下面积(AUC)分别为0.900、0.806、0.762,联合模型的AUC为0.946.结论 MEM、DKI模型和SEM的定量参数可帮助预测LAGC患者新辅助治疗疗效.Objective To investigate the value of quantitative parameters of diffusion weighted imaging(DWI)based on mono-exponential model(MEM),diffusion kurtosis imaging(DKI)model,and stretched-exponential model(SEM)in predicting the efficacy of neoadjuvant therapy in locally advanced gastric cancer(LAGC).Methods Forty LAGC patients who underwent MRI examinations before neoadjuvant therapy and before radical surgery were prospectively enrolled.A radiologist delineated lesions on DWI images and acquired quantitative parameters before and after treatment,including lesion volume,apparent diffusion coefficient(ADC)of MEM,mean diffusivity(MD)and mean kurtosis(MK)of DKI model,distribution diffusion coefficient(DDC),andαof SEM.According to pathological tumor regression grade(TRG),the patients were stratified into good response group(TRG 0-1)and poor response group(TRG 2-3).The pre-treatment parameters andΔof pre-and post-treatment parameters were compared between the two groups with Mann-Whitney U test;multivariate analysis was performed with binary logistic regression.Multiple DWI models and the combined model were established,and the prediction efficiency of each model was calculated.Results There was no significant difference in each parameter before neoadjuvant therapy between the two groups(P>0.05).The delta of volume,ΔADC,ΔMD,andΔDDC pre-and post-treatment were all statistically different between the two groups(P<0.05).The area under the curve(AUC)ofΔADC,ΔMD,andΔDDC in predicting good response for LAGC were 0.900,0.806,and 0.762,respectively.The AUC of the combined model was 0.946.Conclusion Quantitative parameters of MEM,DKI model,and SEM can help predict the efficacy of neoadjuvant-treated LAGC patients.

关 键 词：胃癌 新辅助治疗 磁共振成像 扩散加权成像 

分 类 号：R735.2[医药卫生—肿瘤] R445.2[医药卫生—临床医学]