IVIM-DWI与DCE-MRI定量参数在鼻咽癌近期疗效预测中的应用研究
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摘要
目的探讨体素内不相干运动扩散加权成像(IVIM-DWI)和动态增强磁共振成像(DCE-MRI)的定量参数在鼻咽癌近期疗效预测中的应用价值。方法搜集2017年1月至2018年4月经鼻咽镜活检病理证实并行诱导化疗和同步放化疗的鼻咽癌患者共56例。所有患者均于治疗前行IVIM-DWI和DCE-MRI检查,经后处理测量得到相应的IVIM-DWI参数值:表观扩散系数(ADC)、真实扩散系数(D)、灌注相关扩散系数(D~*)和灌注分数(f);DCE-MRI参数值:容积运转常数(K~(trans))、速率常数(K_(ep))、血管外细胞外容积分数(V_e)和血浆容积分数(V_p)。于同步放化疗结束6个月后再次行MRI检查,根据肿瘤缓解情况,将患者分为治愈组和残留组。分析两组治疗前IVIM-DWI和DCE-MRI各参数的相关性。结果治愈组治疗前ADC值和D值均较残留组低(P值均<0.05),K~(trans)值较残留组高,差异有统计学意义(P<0.05)。其余各参数差异无统计学意义。ADC、D和K~(trans)预测诱导化疗和同步放化疗结束后6个月疗效的受试者工作特征(ROC)曲线下面积(AUC)分别为0.664、0.759、0.711(P值均<0.05)。结论治疗前IVIM-DWI和DCE-MRI定量参数值可对鼻咽癌患者诱导化疗+同步放化疗的近期疗效进行预估,为鼻咽癌个体化治疗提供依据。
Objective To investigate the value of intravoxelincoherent motion diffusion weighted imaging(IVIM-DWI) and dynamic contrast enhanced magnetic response imaging(DCE-MRI) quantitative parameters in early response prediction of nasopharyngeal carcinoma Methods During the period from January 2017 to April 2018,inducing chemotherapy(IC) andconcurrent chemoradiotherapy(CRT) was carried out in 56 patients with pathologically proved nasopharyngealcarcinomaat author's hospital's induction. Pretreatment IVIM-DWI and DCE-MRI was performed in all patients. IVIM-DWI parameters of ADC, D,D~* and f; DCE-MRI parameters of K~(trans),K_(ep),V_e and V_p were calculated. Thepatients were reexamined with MRI 6 months after the end ofchemoradiotherapy. The patients were divided intononresidual group and residual group. The correlations between pretreatment parameters of IVIM-DWI and DCE-MRI were analyzed between the two groups. Results ADC and D values of nonresidual group were lower than residual group(P<0.05),andnonresidual group had higherK~(trans)values than residual group(P<0.05). No significant correlations were found between any other parameters.The area under ROC curve(AUC) of the baseline ADC,D and K~(trans) values used to predict response 6 months after to IC and CRT were 0.664、0.759、0.711(P<0.05). Conclusion The pretreatment IVIM-DWI and DCE-MRI parameters may be useful for prediction for early response of nasopharyngeal carcinoma patients who underwent IC and CRT and may provide a basis for individualized treatment.
Objective To investigate the value of intravoxelincoherent motion diffusion weighted imaging(IVIM-DWI) and dynamic contrast enhanced magnetic response imaging(DCE-MRI) quantitative parameters in early response prediction of nasopharyngeal carcinoma Methods During the period from January 2017 to April 2018,inducing chemotherapy(IC) andconcurrent chemoradiotherapy(CRT) was carried out in 56 patients with pathologically proved nasopharyngealcarcinomaat author's hospital's induction. Pretreatment IVIM-DWI and DCE-MRI was performed in all patients. IVIM-DWI parameters of ADC, D,D~* and f; DCE-MRI parameters of K~(trans),K_(ep),V_e and V_p were calculated. Thepatients were reexamined with MRI 6 months after the end ofchemoradiotherapy. The patients were divided intononresidual group and residual group. The correlations between pretreatment parameters of IVIM-DWI and DCE-MRI were analyzed between the two groups. Results ADC and D values of nonresidual group were lower than residual group(P<0.05),andnonresidual group had higherK~(trans)values than residual group(P<0.05). No significant correlations were found between any other parameters.The area under ROC curve(AUC) of the baseline ADC,D and K~(trans) values used to predict response 6 months after to IC and CRT were 0.664、0.759、0.711(P<0.05). Conclusion The pretreatment IVIM-DWI and DCE-MRI parameters may be useful for prediction for early response of nasopharyngeal carcinoma patients who underwent IC and CRT and may provide a basis for individualized treatment.
引文
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2 赵晓艳,赵鑫,张小安,等.IVIM-DWI与DCE-MRI对宫颈癌的诊断价值和相关性研究[J].实用放射学杂志,2018,34:717-720.
3 Gaeta M,Benedetto C,Minutoli F,et al. Use of diffusion-weighted,intravoxel incoherent motion,and dynamic contrast-enhanced MRimaging in the assessment of response to radiotherapy of lytic bone metastases from breast cancer[J]. Acad Radiol,2014,21:1286-1293.
4 Brizel DM,Dodge RK,Clough RW,Dewhirst MW. Oxygenation ofhead and neck cancer: changes during radiotherapy and impact ontreatment outcome[J].Radiother Oncol,1999,53:113-117.
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6 Yu XP,Hou J,Li FP,et al. Intravoxel incoherent motion MRI for predicting early response to induction chemotherapy and chemoradiotherapy in patients with nasopharyngeal carcinoma[J]. Magn Reson Imaging,2016,43:1179-1190.
7 郭婷婷,刘松,周楠,等.体素内不相干运动磁共振成像评估鼻咽癌同步放化疗疗效[J].磁共振成像,2017,8:254-259.
8 Federau C,Hagmann P,Maeder P,et al. Dependence of brain intravoxel incohenrent motion perusion parameters on the cardic cycle[J].PLoS One,2013,8:e72856.
9 Zhu L,Zhu L,Shi H,et al. Evaluating early response of cervical cancer under concurrent chemo-radiotherapy by intravoxel incoherent motion MR imaging[J]. Bmc Cancer,2016,16:79.
10 Padhani AR,Dzik-Jurasz A. Perfusion MR imaging of extracranialtumor angiogenesis[J]. Top Magn Reson Imaging,2004,15: 41-57.
11 冯煜森,丁莹莹,张娅,等.动态增强磁共振成像在宫颈癌新辅助化疗疗效评估中的价值[J].实用放射学杂志,2018,34:725-729
12 Agrawal S,Awasthi R,Singh A,et al. An exploratory study into the role of dynamic contrast-enhanced(DCE) MRI metrics as predictors of responses in head and neck cancers[J]. Clin Radiol,2012,67:e1-e5.
13 韦超,董江宁,方昕,等.DCE-MRI定量参数预测高强度超声消融术治疗症状性子宫肌瘤首次体积消融率价值[J].临床放射学杂志,2016,35:545-550.
14 Chawla S,Kim S,Dougherty L,et al.Pretreatment diffusion-weighted and dynamic contrast-enhanced MR for prediction of local treatment response in squamous cell carcinomas of the head and neck[J].AJR,2013,200:35-43.
15 郝晓宁,王煊,郭兴华.磁共振成像在宫颈癌新辅助化疗疗效评价的应用[J]. 中国药物与临床,2015,15:802-804.
2 赵晓艳,赵鑫,张小安,等.IVIM-DWI与DCE-MRI对宫颈癌的诊断价值和相关性研究[J].实用放射学杂志,2018,34:717-720.
3 Gaeta M,Benedetto C,Minutoli F,et al. Use of diffusion-weighted,intravoxel incoherent motion,and dynamic contrast-enhanced MRimaging in the assessment of response to radiotherapy of lytic bone metastases from breast cancer[J]. Acad Radiol,2014,21:1286-1293.
4 Brizel DM,Dodge RK,Clough RW,Dewhirst MW. Oxygenation ofhead and neck cancer: changes during radiotherapy and impact ontreatment outcome[J].Radiother Oncol,1999,53:113-117.
5 B?uerle T,Seyler L,Münter M,et al. Diffusion-weighted imaging in rectal carcinoma patients without and after chemoradiotherapy: acomparative study with histology[J]. Eur J Radiol,2013,82:444-452.
6 Yu XP,Hou J,Li FP,et al. Intravoxel incoherent motion MRI for predicting early response to induction chemotherapy and chemoradiotherapy in patients with nasopharyngeal carcinoma[J]. Magn Reson Imaging,2016,43:1179-1190.
7 郭婷婷,刘松,周楠,等.体素内不相干运动磁共振成像评估鼻咽癌同步放化疗疗效[J].磁共振成像,2017,8:254-259.
8 Federau C,Hagmann P,Maeder P,et al. Dependence of brain intravoxel incohenrent motion perusion parameters on the cardic cycle[J].PLoS One,2013,8:e72856.
9 Zhu L,Zhu L,Shi H,et al. Evaluating early response of cervical cancer under concurrent chemo-radiotherapy by intravoxel incoherent motion MR imaging[J]. Bmc Cancer,2016,16:79.
10 Padhani AR,Dzik-Jurasz A. Perfusion MR imaging of extracranialtumor angiogenesis[J]. Top Magn Reson Imaging,2004,15: 41-57.
11 冯煜森,丁莹莹,张娅,等.动态增强磁共振成像在宫颈癌新辅助化疗疗效评估中的价值[J].实用放射学杂志,2018,34:725-729
12 Agrawal S,Awasthi R,Singh A,et al. An exploratory study into the role of dynamic contrast-enhanced(DCE) MRI metrics as predictors of responses in head and neck cancers[J]. Clin Radiol,2012,67:e1-e5.
13 韦超,董江宁,方昕,等.DCE-MRI定量参数预测高强度超声消融术治疗症状性子宫肌瘤首次体积消融率价值[J].临床放射学杂志,2016,35:545-550.
14 Chawla S,Kim S,Dougherty L,et al.Pretreatment diffusion-weighted and dynamic contrast-enhanced MR for prediction of local treatment response in squamous cell carcinomas of the head and neck[J].AJR,2013,200:35-43.
15 郝晓宁,王煊,郭兴华.磁共振成像在宫颈癌新辅助化疗疗效评价的应用[J]. 中国药物与临床,2015,15:802-804.