摘要
目的探讨3.0 T MR DWI预测局部晚期非小细胞肺癌（NSCLC）放疗及同步放化疗疗效的价值。方法2014年1月1日至2015年5月30日40例病理证实为局部晚期（Ⅲa或Ⅲb期） NSCLC且行放疗及同步放化疗的患者，于治疗前行DWI扫描。DWI图像质量分为好、一般、差。DWI图像评价为好和一般的患者于治疗中（放疗剂量20 Gy）和治疗终（放疗剂量60 Gy）再次行DWI检查，测量肿瘤的ADC值，记录肿瘤治疗前（ADCpre）、治疗中（ADCmid）和治疗终（ADCpost）的平均ADC值及其变化率（ΔADCmid、ΔADCpost）。根据实体瘤疗效评价标准RECIST1.1将肿瘤对放疗/同步放化疗的治疗反应评价为完全缓解（CR）、部分缓解（PR）、病变稳定（SD）和病变进展（PD），其中CR、PR归为疗效敏感组；SD、PD归为疗效不敏感组。采用Mann-Whitney U检验比较两组间ADCpre、ADCmid、ADCpost、ΔADCmid、ΔADCpost的差异。应用Spearman等级相关分析评价肿瘤ADCpre、ADCmid、ADCpost、ΔADCmid、ΔADCpost与肿瘤消退率的关系。采用ROC曲线分析各参数判断局部晚期NSCLC放疗及同步放化疗敏感的评价效能，并确定最佳临界值。结果96.4%（80/83）DWI图像质量被评价为好和一般。疗效敏感组ADCpre值[1.32（0.77~1.96）×10-3 mm2/s]低于疗效不敏感组[（1.60（1.12~2.33）×10-3 mm2/s]，差异有统计学意义（Z=－2.934，P=0.003）。NSCLC放疗及同步放化疗结束后肿瘤消退率[（38.1±27.3）%]与ADCpre值呈负相关（r=－0.386，P=0.018）。疗效敏感组ΔADCmid和ΔADCpost分别为38.9%（12.8%~139.0%）、48.3%（25.6%~148.1%），高于疗效不敏感组[ΔADCmid和ΔADCpost分别为－2.5%（－15.0%~29.4%）、14.2%（－28.1%~71.3%）]，差异均具有统计学意义（Z值分别为－2.847、－2.221，P〈0.05）。ΔADCmid、ΔADCpost与肿瘤消退率呈正相关（ΔADCmid：r=0.637，P=0.001；ΔADCpost：r=0.631, P=0.005）。以肿瘤ADCpre=1.38×10-3 mm2/s、ΔADCmid=21.6%、ΔADCpost=38.8%为临界值，预测疗效效能最佳，曲线下面积分别为0.782、0.838、0.813。结论局部晚期NSCLC治疗前的ADC值及其在治疗过程中的变化率可以较好预测放疗及同步放化疗的早期疗效，有望为肺癌个体化治疗提供依据。
Objective To investigate the value of DWI using 3.0 T MRI to predict response to radiotherapy（RT） and concurrent chemoradiotherapy（CCRT） in patients with advanced non-small cell lung cancer （NSCLC）.Methods From January 2014 to May 2015, 40 patients with stageⅢ（Ⅲa orⅢb） NSCLC underwent DWI using 3.0 T MRI before RT/CCRT were enrolled. The imaging quality of diffusion-weighted images were evaluated on 3-level grades as good, moderate and non-diagnostic.The patients with good or＆amp;nbsp;moderate image quality were underwent DWI at 2 weeks after starting therapy（total dose of 20 Gy）, and at the end of therapy （total dose of 60 Gy）. Apparent diffusion coefficient（ADC） of lung cancer with good and moderate image quality were calculated by Funtool. The following quantitative parameters were recorded and calculated： the mean pretreatment ADC value（ADCpre）, the mean mid-treatment ADC value （ADCmid）, the mean post-treatment ADC value（ADCpost）, the rate of changes inmean ADC value at 2 weeks post therapy （ΔADCmid） and the rate of changes inmean ADC value at the end of therapy（ΔADCpost）. The patients were classified into response group and non-response group according to the tumor response, which was assessed with revised response evaluation criteria in solid tumors （RECIST1.1） after CCRT. The Mann-Whitney U test was used to compare parameters between the two groups.The relationship between these obtained parameters and tumor response was evaluated by Spearman correlation analysis. The value of parameters on predicting tumor response was calculated by receiver operating characteristic curve.Results 96.4%（80/83） DW images were graded as good or moderate image quality. The responders had lower median ADCpre[1.32 （0.77—1.96） × 10- 3 mm2/s] than non-responders[1.60（1.12—2.33） × 10- 3 mm2/s], which had statistically significant difference （Z=-2.934,P=0.003）.Tumor regression rate after treatment had negative correlation with ADCpre（r=-0.386, P=0.018）.The responders had increased ADC [ΔADCmid： 38.9%（12.8%—139.0%）,ΔADCpost： 48.3% （25.6%—148.1%）] than non-responders [ΔADCmid： -2.5% （-15%—29.4%）, ΔADCpost：14.2% （- 28.1% —71.3% ）], which had statistically significant difference （Z=- 2.847, - 2.221, respectively;P〈0.05）. Tumor regression rate after treatment had positive correlation with ΔADCmid（r=0.637, P=0.001） and ΔADCpost（r=0.631, P=0.005）.From ROC analysis,when setting threshold on pretreatment ADCpre=1.38 × 10-3 mm2/s, ΔADCmid=21.6%, ΔADCpost=38.8%, the area under curve was 0.782, 0.838 and 0.813.Conclusion The mean ADC value before RT/CCRT and its changes during treatment is likely to be a valuabletool for predicting the response after RT/CCRT in advanced NSCLC, which may be helpful to clinical decision on individualized therapy.
作者
陶秀丽
欧阳汉
吴宁
王绿化
惠周光
叶枫
周丽娜
唐玉
张烨
Tao Xiuli Ouyang Han Wu Ning Wang Lyuhua Hui Zhouguang Ye Feng Zhou Lina Tang Yu Zhang Ye(Department of lmaging Diagnosis,National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences ＆ Peking Union Medical College, Beijing 100021, China)
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2016年第10期740-745,共6页
Chinese Journal of Radiology
基金
国家高技术研究发展计划（2014AA020602）
国家重大科学仪器开发专项（2011YQ17006710）
协和博士创新基金（2013-1002-20）
关键词
肺肿瘤
磁共振成像
疗效对比研究
Lung neoplasms
Magnetic resonance imaging
Comparative effectiveness research
