MRI表观扩散系数和动态增强定量参数评价宫颈鳞癌同步放化疗效果的研究
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摘要
目的探讨磁共振扩散加权成像表观扩散系数(ADC值)和MR动态增强定量参数在宫颈鳞癌同步放化疗前后的相关数据变化,并评估对宫颈鳞癌放化疗疗效的临床价值。方法对75例(其中完全有效组50例,部分有效组25例)接受同步放化疗的宫颈鳞癌患者于治疗前后行常规MRI、DWI和MR动态增强扫描。测量治疗前后肿瘤区的ADC值、K~(trans)、K_(ep)和V_e,并比较ADC值、K~(trans)、K_(ep)和V_e治疗前后各数据差异。采用配对t检验。结果完全有效组治疗前后分别为:ADC_(mean)t=-18.451,P<0.001,差别有统计学意义;K~(trans)t=11.983,P<0.001,差别有统计学意义;K_(ep)t=13.999,P<0.001,差别有统计学意义;V_et=3.606,P=0.001,差别无统计学意义。部分有效组治疗前后分别为:ADC_(mean)t=-8.114,P<0.001,差别有统计学意义;K~(transt)t=8.767,P<0.001,差别有统计学意义;K_(ep)t=8.419,P<0.001,差别有统计学意义;V_et=1.408,P=0.173,差别无统计学意义。治疗后ADC_(mean)检测结果:完全有效均值要高于部分有效,t=11.966,P<0.001,差别有统计学意义;治疗后K~(trans)检测结果:部分有效均值要高于完全有效,t=-1.684,P=0.096,差别无统计学意义;治疗后K_(ep)检测结果:部分有效均值要高于完全有效,t=-1.933,P=0.057,差别无统计学意义;治疗后V_e检测结果:部分有效均值要高于完全有效,t=-0.060,P=0.952,差别无统计学意义。结论 MRI形态学联合扩散加权成像和动态增强扫描能全面精准评价宫颈鳞癌同步放化疗的疗效,ADC值、K~(trans)、K_(ep)等数据在评价疗效中具有重要临床价值。
Objective To investigate the change of related data of diffusionweighted imaging apparent diffusion coefficient(ADC) values and MR dynamic contrast enhanced quantitative parameters pre and post Concurrent Chemoradiotherapy in cervical squamous cell carcinomas, and to evaluate their clinical significance to chemoradiotherapy effect in cervical squamous cell carcinomas. Methods 75 patients(including 50 completelyeffective cases and 25 partly effective cases) of cervicalsquamous cell carcinoma who were treated by Concurrent Chemoradiotherapy were performed by routine MRI, DWI and dynamic contrast enhanced MRI scanningpre and post treatment. The ADC values, K~(trans), K_(ep) and veintumor area were measuredpre and post treatment andthe differences were compared It was adopted by comparison t test. Results The data of completely effective pre and post treatment goup were respectively: ADC_(mean) t=-18.451, P<0.001, with the difference statistically significant; K~(trans) t=11.983, P<0.001, with the difference statistically significant; K_(ep) t=13.999, P<0.001, with the difference statistically significant; V_et=3.606, P=0.001, without significant difference. The data of partly effective pre and post treatment goup were respectively: ADC_(mean) t=-8.114, P<0.001, with the difference statistically significant; K~(trans) t=8.767, P<0.001, with the difference statistically significant; K_(ep) t=8.419, P<0.001, with the difference statistically significant; V_et=1.408, P =0.173, without significant difference. ADC_(mean) test results after treatment: the full effective mean was higher than the partial effective, t=11.966, P<0.001, with the difference statistically significant; K~(trans) test results after treatment: partial effective mean was higher than fully effective, t=-1.684, P=0.096, without significant difference; K_(ep)test results after treatment: partial effective mean was higher than fully effective,t =-1. 933,P = 0. 057,without significant difference; vetest results after treatment: partial effective mean is higher than fully effective,t =-0. 060,P = 0. 952,without significant difference. Conclusion MRI morphology,combined diffusion weighted imaging and dynamic contrast enhanced scan can accurately evaluate the efficacy of concurrent radiotherapy and chemotherapy for squamous cell carcinoma of the cervix,ADC,Ktransand Kepand other data have important clinical value in the evaluation of curative effect.
Objective To investigate the change of related data of diffusionweighted imaging apparent diffusion coefficient(ADC) values and MR dynamic contrast enhanced quantitative parameters pre and post Concurrent Chemoradiotherapy in cervical squamous cell carcinomas, and to evaluate their clinical significance to chemoradiotherapy effect in cervical squamous cell carcinomas. Methods 75 patients(including 50 completelyeffective cases and 25 partly effective cases) of cervicalsquamous cell carcinoma who were treated by Concurrent Chemoradiotherapy were performed by routine MRI, DWI and dynamic contrast enhanced MRI scanningpre and post treatment. The ADC values, K~(trans), K_(ep) and veintumor area were measuredpre and post treatment andthe differences were compared It was adopted by comparison t test. Results The data of completely effective pre and post treatment goup were respectively: ADC_(mean) t=-18.451, P<0.001, with the difference statistically significant; K~(trans) t=11.983, P<0.001, with the difference statistically significant; K_(ep) t=13.999, P<0.001, with the difference statistically significant; V_et=3.606, P=0.001, without significant difference. The data of partly effective pre and post treatment goup were respectively: ADC_(mean) t=-8.114, P<0.001, with the difference statistically significant; K~(trans) t=8.767, P<0.001, with the difference statistically significant; K_(ep) t=8.419, P<0.001, with the difference statistically significant; V_et=1.408, P =0.173, without significant difference. ADC_(mean) test results after treatment: the full effective mean was higher than the partial effective, t=11.966, P<0.001, with the difference statistically significant; K~(trans) test results after treatment: partial effective mean was higher than fully effective, t=-1.684, P=0.096, without significant difference; K_(ep)test results after treatment: partial effective mean was higher than fully effective,t =-1. 933,P = 0. 057,without significant difference; vetest results after treatment: partial effective mean is higher than fully effective,t =-0. 060,P = 0. 952,without significant difference. Conclusion MRI morphology,combined diffusion weighted imaging and dynamic contrast enhanced scan can accurately evaluate the efficacy of concurrent radiotherapy and chemotherapy for squamous cell carcinoma of the cervix,ADC,Ktransand Kepand other data have important clinical value in the evaluation of curative effect.
引文
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[2] 陈金银,林祺,汤琅琅,等.直肠癌表观扩散系数与MR动态增强定量参数的临床价值[J].磁共振成像,2015,6(9):673-676.
[3] 童远和,倪晓雷,王敏,等.磁共振弥散加权成像预测宫颈癌放射敏感性的应用价值[J].中国CT和MRI杂志,2015,13(1):58-60.
[4] 于小平,文露,周彦杰,等.宫颈癌3.0T MR表观弥散系数与动态增强半定量参数的相关性研究[J].医学影像学杂志,2014,24(7):1193-1196.
[5] 邝菲,颜志平,王健,等.3.0TMR扩散加权成像对宫颈癌放化疗疗效的评估价值[J].放射学实践,2014,29(11):1306-1310.
[6] Herneth AM,Guccione S,Bendnarski M.Apparent diffusion coefficient:a quantitati Ve parameter for in vivo tumor characterization [J].Eur Radiol,2003,45(3):208-213.
[7] 朱志军.MRI动态增强定量分析宫颈鳞癌微血管通透性价值的研究[J].中国CT和MRI杂志,2015,13(3):71-73.
[8] Kim SH,Lee JM,Gupta SN,et al.Dynamic contrast-enhanced MRI to evaluate the therapeutic response to neoadjuvant chemoradiation therapy in locally advanced rectal cancer [J].J Magn Reson Imaging,2014,40(3):730-737.
[9] 闫铄,夏爽.定量动态增强在头颈部肿瘤中的研究进展[J].国际医学放射学杂志,2014,37(3):238-241.
[10] Chawla S,Kim S,Dougherth L,et al.Pretreatment diffusion-weighted and dynamic contrast-enhanced MRI for prediction of local treatment response in squamous cell carcinomas of the head and neck [J].AJR,2013,200(1):35-43.
[11] Freeman SJ,Aly AM,Kataoka MY,et al.The revised FIGO staging system for uterine malignancies:implications for MR imaging [J].Radiographics,2012,32(6):1805-1827.
[12] 周忠洁,王小蓉,赵晓君,等.MR扩散加权成像在宫颈癌诊断和分期中的应用[J].医学影像学杂志,2013,23(11):1752-1755.