不同b值的磁共振扩散加权成像在评估食管癌同步放化疗疗效中的价值
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摘要
目的利用不同b值的表面扩散系数(Apparent Diffusion Coefficient,ADC)值评价食管癌放化疗的疗效。方法前瞻性分析我院行放化疗的食管癌患者30例。于放化疗前及放化疗结束后分别行常规MRI及多b值的DWI扫描,b值选择为0～500、0～800和0～1000 sec/mm~2。测量并观察食管癌灶ADC(ADC_(2max)、ADC_(2min)及ADC_(2mean))值的变化,疗效根据RECIST标准评价。结果 30例食管癌患者中,除5例未完成磁共振检查,3例病灶无法测量外,其余22例食管癌患者完全缓解13例(59.1%)、部分缓解9例(40.9%)。放化疗后ADC值较放化疗前均升高。当b=0～500及0～800 sec/mm~2时,治疗后病灶ADC值(ADC_(2max)、ADC_(2min)及ADC_(2mean))在不同疗效组间均存在显著差异(P<0.05)。而当b值为0～1000 sec/mm~2时,病灶的ADC值在不同疗效组间均无显著差异(P>0.05)。b值区间(b=0～500及0～800 sec/mm~2),ADC值(ADC_(2max)、ADC_(2min)及ADC_(2mean))在预测食管癌放化疗疗效时的曲线下面积为0.817～0.897。结论 b值0～500 sec/mm~2、0～800 sec/mm~2时ADC值作为预测食管癌放化疗效果的指标具有可行性。
Objective To evaluate the ef?cacy of chemoradiotherapy for esophageal cancer using apparent diffusion coef?cient(ADC)values with different b values. Methods A prospective analysis was conducted on the 30 cases of esophageal cancer treated with radiotherapy and chemotherapy in our hospital. Routine magnetic resonance imaging(MRI) and diffusion weighted imaging with multiple b values were performed before and after chemoradiotherapy, respectively. The b values were selected as 0-500, 0-800 and0-1000 sec/mm~2. The changes of ADC_(2max), ADC_(2min) and ADC_(2mean) values of esophageal carcinoma were measured and observed.Results The curative effect was evaluated according to RECIST Among the 30 cases of esophageal cancer, 13 cases(59.1%) had complete remission and 9 cases(40.9%) had partial remission, except that 5 cases did not complete MRI examination and 3 cases could not measure the lesion. ADC values were higher after chemoradiotherapy than before chemoradiotherapy. The ADC values after chemoradiotherapy were higher than that before. When b=0-500 and 0-800 sec/mm~2, the ADC values(ADC_(2max),ADC_(2min) and ADC_(2mean)) of the lesions after treatment showed signi?cant differences between different therapeutic groups(P<0.05).However, when the b value was 0-1000 sec/mm~2, there was no signi?cant difference in ADC values between different therapeutic groups(P> 0.05). The b values range(b=0-500 and 0-800 sec/mm~2) and ADC values(ADC_(2max), ADC_(2min), and ADC_(2mean)) had areas of0.817-0.897 under the curve when predicting the ef?cacy of chemoradiotherapy for esophageal cancer. Conclusion It is feasible to use ADC values of 0-500 sec/mm~2 and 0-800 sec/mm~2 as indicators to predict the effects of radiotherapy and chemotherapy for esophageal cancer.
Objective To evaluate the ef?cacy of chemoradiotherapy for esophageal cancer using apparent diffusion coef?cient(ADC)values with different b values. Methods A prospective analysis was conducted on the 30 cases of esophageal cancer treated with radiotherapy and chemotherapy in our hospital. Routine magnetic resonance imaging(MRI) and diffusion weighted imaging with multiple b values were performed before and after chemoradiotherapy, respectively. The b values were selected as 0-500, 0-800 and0-1000 sec/mm~2. The changes of ADC_(2max), ADC_(2min) and ADC_(2mean) values of esophageal carcinoma were measured and observed.Results The curative effect was evaluated according to RECIST Among the 30 cases of esophageal cancer, 13 cases(59.1%) had complete remission and 9 cases(40.9%) had partial remission, except that 5 cases did not complete MRI examination and 3 cases could not measure the lesion. ADC values were higher after chemoradiotherapy than before chemoradiotherapy. The ADC values after chemoradiotherapy were higher than that before. When b=0-500 and 0-800 sec/mm~2, the ADC values(ADC_(2max),ADC_(2min) and ADC_(2mean)) of the lesions after treatment showed signi?cant differences between different therapeutic groups(P<0.05).However, when the b value was 0-1000 sec/mm~2, there was no signi?cant difference in ADC values between different therapeutic groups(P> 0.05). The b values range(b=0-500 and 0-800 sec/mm~2) and ADC values(ADC_(2max), ADC_(2min), and ADC_(2mean)) had areas of0.817-0.897 under the curve when predicting the ef?cacy of chemoradiotherapy for esophageal cancer. Conclusion It is feasible to use ADC values of 0-500 sec/mm~2 and 0-800 sec/mm~2 as indicators to predict the effects of radiotherapy and chemotherapy for esophageal cancer.
引文
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[14]郑向东,李天然,吴贵成,等.3.0 T MR弥散加权成像对食管癌放化疗的疗效评价[J].功能与分子医学影像学杂志,2015(1):579-582.
[15]张明,吴献华.磁共振弥散加权成像对食管癌患者同期放化疗前后表观弥散系数以及病变长度的影响[J].中国临床研究,2016,29(3):389-391.
[16]刘小静,周胜利,陈伟,等.磁共振扩散加权成像在食管癌显示及恶性程度评估中的应用[J].临床放射学杂志,2016,(5):763-767.
[17]Baba Y,Watanabe M,Baba H.A review of the alterations in DNA methylation in esophageal squamous cell carcinoma[J]Surgery Today,2013,43(12):1355-1364.
[2]余小多,林蒙,欧阳汉,等.3.0 T MR扩散加权成像诊断肾脏恶性肿瘤[J].中国医学影像技术,2010,26(3):538-542.
[3]黄薇园,余永强,钱银锋,等.MR扩散加权成像瘤周水肿区ADC值在脑肿瘤鉴别诊断中的价值[J].临床放射学杂志,2010,20(1):27-30.
[4]Lei J,Tian Y,Zhu SC,et al.Preliminary study of IVIM-DWI and DCE-MRI in early diagnosis of esophageal cancer[J].Eur Rev Med Pharmacol Sci,2015,19(18):3345-3350.
[5]Eisenhauer EA,Therasse P,Bogaerts J,et al.New response evaluation criteria in solid tumours:revised RECIST guideline(version 1.1)[J].Eur J Cancer,2009,45(2):228-247.
[6]尚全良,肖恩华,贺忠,等.肝癌经导管动脉灌注化疗栓塞术疗效的M R扩散加权成像动态研究[J].中华放射学杂志,2006,(3):235-240.
[7]Lin Y,Li J,Zhang Z,et al.Comparison of intravoxel incoherent motion diffusion-weighted MR imaging and arterial spin labeling MR imaging in gliomas[J].Biomed Res Int,2015,1-10.
[8]曾治民,廖琴,蔡婧,等.磁共振扩散加权成像及ADC值测量对非小细胞肺癌肺门纵隔淋巴结的鉴别诊断价值[J].中国肿瘤临床,2012,39(10):706-710.
[9]陈欣,闫锐,康华峰,等.不同扩散梯度因子值的乳腺MR扩散加权成像对比研究[J].中华放射学杂志,2009,43(4):356-359.
[10]Shinmoto H,Tamura C,Soga S,et al.An intravoxel incoherent motion diffusion-weighted imaging study of prostate cancer[J]Ajr Am J Roentgenol,2012,199(4):496-500.
[11]孙应实,张晓鹏,唐磊.直肠癌扩散加权成像b值选取及其对直肠癌显示能力的评价[J].中国医学影像技术,2 0 0 521(12):1839-1843.
[12]Wang L,Liu L,Han C,et al.The diffusion-weighted magnetic resonance imaging(DWI)predicts the early response of esophageal squamous cell carcinoma to concurrent chemoradiotherapy[J].Radiother Oncol,2016,121(2):246-251.
[13]刘辉,时高峰,邵娴,等.磁共振弥散加权成像在食管癌放疗疗效中的应用以及评价价值[J].中国现代医学杂志,201424(22):57-61.
[14]郑向东,李天然,吴贵成,等.3.0 T MR弥散加权成像对食管癌放化疗的疗效评价[J].功能与分子医学影像学杂志,2015(1):579-582.
[15]张明,吴献华.磁共振弥散加权成像对食管癌患者同期放化疗前后表观弥散系数以及病变长度的影响[J].中国临床研究,2016,29(3):389-391.
[16]刘小静,周胜利,陈伟,等.磁共振扩散加权成像在食管癌显示及恶性程度评估中的应用[J].临床放射学杂志,2016,(5):763-767.
[17]Baba Y,Watanabe M,Baba H.A review of the alterations in DNA methylation in esophageal squamous cell carcinoma[J]Surgery Today,2013,43(12):1355-1364.