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.
引文
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