IVIM-DWI与DCE-MRI定量参数对宫颈鳞癌同步放化疗早期疗效预测的价值

doi:10.3760/cma.j.cn113030-20200202-00038

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摘要目的研究体素内不相干运动扩散加权成像(IVIM-DWI)与动态增强MRI (DCE-MRI)在宫颈鳞癌同步放化疗(CCRT)早期疗效预测中的应用价值。方法纳入 50例经病理证实的宫颈鳞癌患者,于CCRT前行IVIM-DWI和DCE-MRI扫描,测量所有患者治疗前IVIM-DWI定量参数ADC、D、D^*、f及DCE-MRI定量参数K^trans、Kep、Ve、Vp的值。并于CCRT结束后1个月行MRI复查,根据肿瘤缓解情况分为治愈组和残留组。对两组治疗前IVIM-DWI和DCE-MRI各参数进行比较。并通过绘制受试者工作特性(ROC)曲线找到最佳预测参数及其预测阈值。结果治愈组 24例,残留组 26例。治愈组治疗前的ADC、D和Ve值明显低于残留组(均 P<0.05),f值和K^trans值明显高于残留组(均 P<0.05)。其他参数均相近(均 P>0.05)。D的ROC曲线下面积(AUC=0.823)最大,其次是K^trans (AUC=0.754),D与K^trans的联合预测效能(AUC=0.867)高于D、K^trans单独预测,其敏感性分别为88.5%、85.8%、88.8%,特异性分别为70.8%、66.7%、79.2%。结论治疗前IVIM-DWI与DCE-MRI的定量参数对宫颈鳞癌CCRT早期疗效具有一定的预测价值,其中D值的预测效能最佳,D与K^trans的联合应用可提高预测效能。

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	郑小敏
	钱立庭
	董江宁
	刘云琴
	方昕
	李翠平

关键词 ：磁共振成像, 体素内不相干运动扩散加权成像, 动态对比增强, 宫颈肿瘤/同步放化疗法, 疗效预测

Abstract：Objective To evaluate the application value of intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI) and dynamic contrast enhancement MRI (DCE-MRI) in the prediction of the early efficacy of concurrent chemoradiotherapy (CCRT) for cervical squamous cell carcinoma. Methods Fifty patients with cervical squamous cell carcinoma confirmed by pathology were included. Before CCRT, IVIM-DWI and DCE-MRI were scanned, and the values of quantitative parameters including ADC, D, D^* and f of IVIM-DWI and K^trans, Kep, Ve and Vp of DCE-MRI before treatment were measured for all patients. MRI reexamination was performed 1 month after the end of CCRT, and all patients were divided into the cure group and the residual group according to the tumor remission. The parameters of IVIM-DWI and DCE-MRI before treatment were statistically compared between two groups. The optimal predictive parameters and predictive thresholds were determined by drawing the receiver operating characteristic (ROC) curve. Results Twenty-four patients were assigned into the cure group and twenty-six patients in the residual group. The ADC, D and Ve values before treatment in the cure group were significantly lower than those in the residual group (all P<0.05), whereas the f and K^trans values were significantly higher than those in the residual group (both P<0.05). The other parameters did not significantly differ between two groups (all P>0.05). The area under ROC curve (AUC=0.823) of D value was the largest, followed by K^transvalue (AUC=0.754). The combined prediction efficacy of D and K^trans (AUC=0.867) was higher than that of either D or K^trans alone. The sensitivity was 88.5%, 85.8% and 88.8%, and the specificity was 70.8%, 66.7% and 79.2%, respectively. Conclusions Quantitative parameters of IVIM-DWI and DCE-MRI before treatment have certain predictive value for the early efficacy of CCRT in cervical squamous cell carcinoma, among which the predictive efficacy of D value is the highest, and the combined application of D and K^trans can improve the predictive efficacy.

Key words： Magnetic resonance imaging Intravoxel incoherent motion diffusion weighted imaging Dynamic contrast-enhanced Cervical neoplasm/concurrent chemoradiotherapy Efficacy prediction

收稿日期: 2020-02-02

基金资助:安徽省重点研究和开发计划项目(1804h08020294)

通讯作者: 钱立庭,Email:money2004@sina.com;董江宁,Email:dongjn@163.com

引用本文:

郑小敏,钱立庭,董江宁等. IVIM-DWI与DCE-MRI定量参数对宫颈鳞癌同步放化疗早期疗效预测的价值[J]. 中华放射肿瘤学杂志, 2020, 29(8): 654-660.

Zheng Xiaomin,Qian Liting,Dong Jiangning et al. Predictive value of IVIM-DWI and DCE-MRI quantitative parameters on the early efficacy of concurrent chemoradiotherapy for cervical squamous cell carcinoma[J]. Chinese Journal of Radiation Oncology, 2020, 29(8): 654-660.

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http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.cn113030-20200202-00038 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2020/V29/I8/654

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