IVIM双指数及拉伸指数模型评估宫颈癌放化疗疗效的价值
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摘要
目的:探讨体素内不相干加权运动磁共振成像双指数、拉伸指数模型评估宫颈癌放化疗疗效的价值。方法:30例经活检证实为宫颈癌的患者放化疗前、放化疗1个月后行MRI扫描,扫描序列包括矢状面T_2WI,横轴面T_2WI、T_1WI、DWI、IVIM(12个b值,范围0～2000s/mm~2)。双指数模型测得病变区纯水分子扩散系数(D)、伪扩散系数(D*)、灌注分数(f),拉伸指数模型测得水分子扩散异质性指数(α),扩散分布系数(DDC)。测量各扫描时间点肿瘤最大面积及相关参数,并分析其动态变化及相关性。结果:宫颈癌病灶的D值、f值、DDC值在放化疗后升高,分别由0.642×10~(-3 )mm~2/s,18.8%,0.84×10~(-3 )mm2/s升高至0.777×10~(-3 )mm~2/s,36.3%,2.2×10~(-3 )mm~2/s差异有统计学意义(P<0.05);α、D*值在放化疗前后分别为0.775,9.59×10~(-3 )mm~2/s至0.486,39.8×10~(-3 )mm~2/s差异无统计学意义(P>0.05)。结论:IVIM双指数、拉伸指数相关参数可动态监测宫颈癌放化疗过程中的细微变化,D值、DDC值能有效监测放化疗疗效,f值可作为放化疗疗效的潜在观察指标。
Objective:To evaluate the efficacy of radiotherapy and chemotherapy for cervical cancer with intravoxel incoherent weighted motion magnetic resonance imaging(IVIMI)bi-index and stretch index models.Methods:Thirty patients with cervical cancer confirmed by biopsy underwent MRI scan before and one month after radiotherapy and chemotherapy.Scan sequences included saggittal T_2WI,axial T_2WI,T_1WI,DWI,IVIM(12bvalues,range 0～2000s/mm~2).The diffusion coefficient(D),pseudo-diffusion coefficient(D*)and perfusion fraction(f)of pure water molecules in the lesion area were measured under the bi-index mode.The water molecule diffusion heterogeneity index(α)and the diffusion distribution coefficient(DDC)were measured under the stretch index mode.The maximum tumor area and related parameters were measured at each scanning time point,and the dynamic changes and correlations were analyzed.Results:The D value,f value and DDC value of cervical cancer lesions increased after chemotherapy and radiotherapy,ranging from 0.642×10~(-3 )mm~2/s,18.8%,0.84×10~(-3 )mm~2/s to 0.777×10~(-3 )mm~2/s,36.3%,2.2×10~(-3 )mm~2/s.The difference was statistically significant(P<0.05);α,D*values were 0.775,9.59×10~(-3 )mm~2/s to 0.486,39.8×10~(-3 )mm~2/s before and after radiotherapy and chemotherapy.The difference was not statistically significant(P>0.05).Conclusion:The IVIM bi-index and stretch index related parameters can dynamically monitor the subtle changes in the course of radiotherapy and chemotherapy of cervical cancer.D value and DDC value can effectively monitor the efficacy of radiotherapy and chemotherapy.The f value can be used as a potential observation index for the efficacy of radiotherapy and chemotherapy.
Objective:To evaluate the efficacy of radiotherapy and chemotherapy for cervical cancer with intravoxel incoherent weighted motion magnetic resonance imaging(IVIMI)bi-index and stretch index models.Methods:Thirty patients with cervical cancer confirmed by biopsy underwent MRI scan before and one month after radiotherapy and chemotherapy.Scan sequences included saggittal T_2WI,axial T_2WI,T_1WI,DWI,IVIM(12bvalues,range 0～2000s/mm~2).The diffusion coefficient(D),pseudo-diffusion coefficient(D*)and perfusion fraction(f)of pure water molecules in the lesion area were measured under the bi-index mode.The water molecule diffusion heterogeneity index(α)and the diffusion distribution coefficient(DDC)were measured under the stretch index mode.The maximum tumor area and related parameters were measured at each scanning time point,and the dynamic changes and correlations were analyzed.Results:The D value,f value and DDC value of cervical cancer lesions increased after chemotherapy and radiotherapy,ranging from 0.642×10~(-3 )mm~2/s,18.8%,0.84×10~(-3 )mm~2/s to 0.777×10~(-3 )mm~2/s,36.3%,2.2×10~(-3 )mm~2/s.The difference was statistically significant(P<0.05);α,D*values were 0.775,9.59×10~(-3 )mm~2/s to 0.486,39.8×10~(-3 )mm~2/s before and after radiotherapy and chemotherapy.The difference was not statistically significant(P>0.05).Conclusion:The IVIM bi-index and stretch index related parameters can dynamically monitor the subtle changes in the course of radiotherapy and chemotherapy of cervical cancer.D value and DDC value can effectively monitor the efficacy of radiotherapy and chemotherapy.The f value can be used as a potential observation index for the efficacy of radiotherapy and chemotherapy.
引文
[1]刘慧强.我国宫颈癌流行病学特征和高危因素分析[J].中国妇幼保健,2016,31(6):1258-1260.
[2]和吉娣.宫颈癌筛查状况与临床治疗研究进展[J].影像研究与医学应用,2017,1(15):236-237.
[3]李靖,曲金荣,张宏凯,等.体素内不相干运动成像评估局部晚期宫颈癌同步放化疗疗效的价值[J].中华放射学杂志,2018,52(3):192-198.
[4]罗是是,孔祥泉.宫颈癌的MR功能成像[J].放射学实践,2011,26(5):567-569.
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[6]Bihan DL,Turner R,Macfall JR,et al.Effects of intravoxel incoherent motions(IVIM)in steady-state free precession(SSFP)imaging:application to molecular diffusion imaging[J].Magn Res Med,1989,10(3):324-337.
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[8]Payne GS,Schmidt M,Morgan VA,et al.Evaluation of magnetic resonance diffusion and spectroscopy measurements as predictive biomarkers in stage 1cervical cancer[J].Gynecol Oncol,2010,116(2):246-252.
[9]郭婷婷,刘松,周楠,等.体素内不相干运动磁共振成像评估鼻咽癌同步放化疗疗效[J].磁共振成像,2017,8(4):254-259.
[10]Jia QJ,Zhang SX,Chen WB,et al.Initial experience of correlating parameters of intravoxel incoherent motion and dynamic contrast-enhanced magnetic resonance imaging at 3.0Tin nasopharyngeal carcinoma[J].Eur Radiol,2014,24(12):3076-3087.
[11]程楠,吕星海,任克,等.IVIM-DWI多模型参数分析对宫颈癌的诊断价值[J].放射学实践,2017,32(2):157-161.
[12]解卓.基于多b值弥散加权成像的双指数、拉伸指数模型在乳腺疾病诊断中的临床价值研究[D/OL].西安:第四军医大学,2016[2017-07-26].http://www.wanfangdata.com.cn/details/detail.do?_type=degree&id=D01104680.
[13]王立侠,刘佩芳,叶兆祥.DWI在宫颈癌诊断和放疗后疗效评价中的价值[J].放射学实践,2014,29(2):136-139.
[14]Federau C,Hagmann P,Maeder P,et al.Dependence of brain intravoxel incoherent motion perfusion parameters on the cardiac cycle[J].Plos One,2013,8(8):e72856.
[15]孟楠,闫瑞芳,任继鹏,等.单指数、双指数及拉伸指数模型扩散加权成像参数诊断子宫内膜癌[J].中国医学影像学杂志,2017,25(8):609-612.
[16]马婉玲,魏梦绮,任静,等.拉伸指数与单指数模型多b值DWI定量参数在胰腺癌的对照研究[J].临床放射学杂志,2017,36(12):1793-1797.
[17]安慧蒙,郑荣芳,梁盼盼,等.放化疗治疗Ⅱb~Ⅳa期局部晚期宫颈癌有效性与安全性的meta分析[J].现代妇产科进展,2018,27(1):18-22.
[2]和吉娣.宫颈癌筛查状况与临床治疗研究进展[J].影像研究与医学应用,2017,1(15):236-237.
[3]李靖,曲金荣,张宏凯,等.体素内不相干运动成像评估局部晚期宫颈癌同步放化疗疗效的价值[J].中华放射学杂志,2018,52(3):192-198.
[4]罗是是,孔祥泉.宫颈癌的MR功能成像[J].放射学实践,2011,26(5):567-569.
[5]周程,徐列印.磁共振扩散加权成像及动态增强扫描对宫颈癌放化疗疗效评估的应用[J].华夏医学,2016,29(5):134-138.
[6]Bihan DL,Turner R,Macfall JR,et al.Effects of intravoxel incoherent motions(IVIM)in steady-state free precession(SSFP)imaging:application to molecular diffusion imaging[J].Magn Res Med,1989,10(3):324-337.
[7]Bennett KM,Schmainda KM,Bennett RT,et al.Characterization of continuously distributed cortical water diffusion rates with a stretched-exponential model[J].Magn Res Med,2003,50(4):727-734.
[8]Payne GS,Schmidt M,Morgan VA,et al.Evaluation of magnetic resonance diffusion and spectroscopy measurements as predictive biomarkers in stage 1cervical cancer[J].Gynecol Oncol,2010,116(2):246-252.
[9]郭婷婷,刘松,周楠,等.体素内不相干运动磁共振成像评估鼻咽癌同步放化疗疗效[J].磁共振成像,2017,8(4):254-259.
[10]Jia QJ,Zhang SX,Chen WB,et al.Initial experience of correlating parameters of intravoxel incoherent motion and dynamic contrast-enhanced magnetic resonance imaging at 3.0Tin nasopharyngeal carcinoma[J].Eur Radiol,2014,24(12):3076-3087.
[11]程楠,吕星海,任克,等.IVIM-DWI多模型参数分析对宫颈癌的诊断价值[J].放射学实践,2017,32(2):157-161.
[12]解卓.基于多b值弥散加权成像的双指数、拉伸指数模型在乳腺疾病诊断中的临床价值研究[D/OL].西安:第四军医大学,2016[2017-07-26].http://www.wanfangdata.com.cn/details/detail.do?_type=degree&id=D01104680.
[13]王立侠,刘佩芳,叶兆祥.DWI在宫颈癌诊断和放疗后疗效评价中的价值[J].放射学实践,2014,29(2):136-139.
[14]Federau C,Hagmann P,Maeder P,et al.Dependence of brain intravoxel incoherent motion perfusion parameters on the cardiac cycle[J].Plos One,2013,8(8):e72856.
[15]孟楠,闫瑞芳,任继鹏,等.单指数、双指数及拉伸指数模型扩散加权成像参数诊断子宫内膜癌[J].中国医学影像学杂志,2017,25(8):609-612.
[16]马婉玲,魏梦绮,任静,等.拉伸指数与单指数模型多b值DWI定量参数在胰腺癌的对照研究[J].临床放射学杂志,2017,36(12):1793-1797.
[17]安慧蒙,郑荣芳,梁盼盼,等.放化疗治疗Ⅱb~Ⅳa期局部晚期宫颈癌有效性与安全性的meta分析[J].现代妇产科进展,2018,27(1):18-22.