DCE-MRI定量参数在溶骨型脊柱转移瘤射波刀立体定向放疗疗效评价中的应用研究被引量：2

Use of Dynamic Contrast-Enhanced Magnetic Resonance Imaging in Assessment of Treatment Outcome After Cyberknife Stereotactic Radiosurgery for Patients with OsteolyticSpinal Metastases

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摘要目的探讨动态对比增强磁共振成像(DCE-MRI)定量参数评价溶骨型脊柱转移瘤射波刀立体定向放疗早期疗效的价值。方法前瞻性选择接受射波刀治疗的溶骨型脊柱转移瘤患者。全部患者于治疗前和治疗后第3个月行DCE-MRI检查,经后处理得到相应的DCE-MRI定量参数:容积运转常数(K^trans)、速率常数(Kep)、血管外细胞外容积分数(Ve)。根据实体肿瘤疗效评价标准将病灶分为进展组与非进展组,分析比较两组间治疗前后定量参数变化,并通过受试者工作特征曲线评价上述各参数的诊断效能。结果共纳入17例(27病灶),非进展组共21个病灶,进展组6个病灶。其中post-K^trans、post-Kep、ΔK^trans、ΔKep在两组间存在统计学差异,其余各参数无统计学差异。非进展组的post-K^trans和post-Kep(0.181 min^-1和0.856 min^-1)要显著低于进展组(0.284 min^-1和1.204 min^-1)。非进展组ΔK^trans和ΔKep(-38.9%和-32.8%)显著小于进展组(-4.3%和-5.4%)。其中ΔK^trans诊断效能最高,曲线下面积为0.905,随后依次为post-K^trans、ΔKep、post-Kep,曲线下面积分别为0.833、0.817和0.810。结论DCE-MRI在判定射波刀治疗疗效方面具有很高的准确性,能够为今后的临床实践提供有价值的信息。 Objective To explore the value of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)for evaluating outcomes of CyberKnife radiosurgery for osteolyticspinal metastases.Methods We enrolled patients with spinal metastases who were treated with CyberKnife radiosurgery at Peking University Third Hospital from July 2018 to June 2019.Conventional MRI and DCE-MRI were performed before treatment and at 3 months after treatment.Patients were defined as the progressive disease(PD)group and the non-PD group.The hemodynamic parameters(K^trans,Kep,Ve)before and after treatment between the groups were analyzed.Area under the curve(AUC)values were calculated.Results Seventeen patients with 27 lesions were included,of which 21 and six lesions were categorized into the non-PD and PD groups,respectively.Post-K^trans,post-Kep,ΔK^trans andΔKep were significantly different between the two groups,the other parameters had no statistical difference.Post-K^trans and post-Kep in the non-PD group(0.181 min^-1 and 0.856 min^-1,respectively)were significantly lower than the corresponding values in the PD group(0.284 min^-1 and 1.204 min^-1;P<0.05).ΔK^trans andΔKep in the non-PD group(-38.9%and-32.8%,respectively)were significantly lower than the corresponding values in PD group(-4.3%and-5.4%;P<0.05).ΔK^trans had the highest diagnostic efficiency,with an AUC of 0.905,the AUC values for post-K^trans,ΔKep,and post-Kep were 0.833,0.817,and 0.810,respectively.Conclusion DCE-MRI could be used to determine the outcome of CyberKnife radiosurgery with high accuracy and provide valuable information for future clinical practice.