摘要
目的:探讨动态增强MRI(DCE-MRI)对宫颈鳞癌同步放化疗疗效的预测价值。方法:研究对象选取2009年10月-2012年1月于我院行同步放化疗、并于治疗前、治疗末(常规治疗结束时)行DCE-MRI扫描的88例宫颈鳞癌患者。测量治疗前肿瘤及肌层DCE-MRI的时间信号强度曲线(TIC)类型及半定量参数,并计算肿瘤与肌层的比值,包括相对正性增强积分(rPEI)、相对最大上升斜率(rMSI)、相对最大下降斜率(rMSD)、增强后15s、30s、45s及60s的相对信号增强比率(rSER)、相对最大信号增强比率(rSERmax)及肿瘤达峰时间(TTP)。于治疗末依据肿瘤残存情况分为完全缓解(CR)组(56例)及部分缓解(PR)组(32例),对组间DCE-MRI半定量参数进行统计学比较,并采用受试者工作特征(ROC)曲线分析治疗前参数预测治疗末肿瘤残存的诊断阈值及效能。结果:CR组治疗前rPEI、rMSI、rSER15、rSER30及rSER45均高于PR组,且差异均有统计学意义(P值分别为<0.001、<0.001、0.045、<0.001及<0.001)。ROC曲线分析显示以治疗前rPEI≤0.84预测肿瘤同步放化疗后残存,其敏感度、特异度、阳性预测值、阴性预测值及诊断符合率分别为75.0%、69.6%、58.5%、83.0%及71.6%,曲线下面积(AUC)为0.785(P<0.001)。结论:治疗前DCE-MRI半定量参数能在一定程度上预测宫颈鳞癌治疗结束时的疗效,有助于临床实施肿瘤个体化精确治疗。
Objective： To assess the value of DCE derived semiquantitative parameters in predicting the efficacy of concurrent chemoradiotherapy in cervical squamous cell carcinoma by using 3.0T DCE-MRI （dynamic contrast-enhanced magnetic resonance imaging）. Methods：Consecutive 88 cases of cervical squamous cell carcinoma with concurrent chemora- diotherapy in our hospital from October 2009 to January 2012 were included in our study. Pretreatment DCE derived TIC （time-signal intensity curve） and relative semiquantitative parameters in both tumor tissue and myometrium,including rPEI （relative positive enhancement integral）,rMSI （relative maximum slop of increase）, rMSD （relative maximum slop of de- crease）, rSER （relative signal enhancement ratio） at 15s, 30s, 45s and 60s after contrast agent administration, rSERmax （relative maximum signal enhancement ratio） and TTP （time to peak） were measured and statistically rendered. The pa- tients were divided into CR （complete regression） group and PR （partial regression） group according to the tumor response at the end of routine treatment. Mann-Whitney U test was used to compare the pretreatment DCE parameters between the two groups,and ROC was used to assess the value of the pretreatment DCE parameters in predicting chemoradiotherapy ef- ficacy. Results：At the end of routine treatment, there were 52 cases in CR group and 36 cases in PR group. Pretreatment rPEI,rMSI,rSER15, rSER30 and rSER45 of CR group were higher than those of PR group with statistical significant differences （PG0. 001,d0. 001,0. 045,G0. 001 and G0. 001,respectively）. ROC curve analysis showed when setting pre- treatment rPEI threshold at lower than and equal to 0.88 for predicting PR, the specificity, sensitivity, positive predictive value, negative predictive value and accuracy were 75.0 ~, 69.6 ~, 58.5 %, 83.0 % and 71.6 % respectively, with area under curve of 0. 785 （PG0. 001）. Conclusion：Pretreatment DCE-MRI derived parameters had potential to predict the concurrent chemoradiotherapy efficacy in cervical squamous cell carcinoma,which may help in individualized therapy.
出处
《放射学实践》
2014年第2期131-135,共5页
Radiologic Practice
基金
北京希望马拉松专项基金资助(LC2010B32)
关键词
宫颈肿瘤
磁共振成像
动态增强扫描
治疗结果
Uterine cervical neoplasms
Magnetic resonance imaging
Dynamic contrast-enhanced scan
Treatment outcome
