高分辨率扩散加权成像对比扩散峰度成像在预测鼻咽癌放疗疗效中的应用

doi:10.3760/cma.j.issn.1004-4221.2018.07.002

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摘要

目的前瞻性研究对比高分辨率磁共振扩散加权成像(DWI)与扩散峰度成像(DKI)预测鼻咽癌放疗反应。方法经病理证实的鼻咽癌患者41例均行IMRT。所有患者分别于放疗前、放疗结束时(达计划剂量后1~2 d)行常规MR、高分辨率DWI和DKI检查,并于放疗结束后3、6、9个月和1年行常规MR随访。按照Resist1.1标准评估疗效,将患者分为放疗敏感组(RG) 和放疗抵抗组(NRG)。分析放疗前及放疗结束时的DKI参数平均峰度系数(Kmean)、平均扩散系数(Dmean)和高分辨率 DWI参数表观扩散系数(ADC)值。结果 41例患者中36例为RG组,5例为NRG组。除放疗前的Dmean和ADC值外,放疗前及放疗结束时其他参数均不同(P=0.000~0.013)。放疗结束时Kmean值预测局控的敏感度为87.5%,特异度为 91.3%(临界值为0.30,AUC为0.924;95%CI为0.83~1.00)。结论放疗结束时的Kmean值具有早期预测鼻咽癌放疗疗效的潜力。

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	吴刚
	黄薇园
	王奋
	黄光
	张帅
	杨时平
	陈峰
	林少民

关键词 ：鼻咽肿瘤/放射疗法, 扩散加权成像, 扩散峰度成像

Abstract：

Objective In this prospective study,the performance between high-resolution diffusion-weighted imaging (DWI) and diffusion kurtosis imaging (DKI) for prediction of radiotherapy response in patients with nasopharyngeal carcinoma was compared. Methods Forty-one patients pathologically diagnosed with NPC received IMRT. All patients underwent conventional MRI,high-resolution DWI and DKI before and after radiotherapy (1-2 d after the plan dose was administered). All patients received conventional MRI during follow-up at 3,6,9 and 12 months after radiotherapy. According to the RECIST 1.1(response evaluation criteria in solid tumors),all patients were divided into the response group (RG;n=36) and non-response group (NRG;n=5). The mean kurtosis coefficient (Kmean) and the mean diffusion coefficient (Dmean) of DKI and apparent diffusion coefficient (ADC) of DWI were analyzed before and after radiotherapy. Results Among 41 patients,36 cases were assigned into the RG group and 5 in the NRG group. Before and after radiotherapy,all parameters significantly differed between two groups (P=0.000-0.013) except for the Dmean and ADC prior to radiotherapy. At the end of radiotherapy,the sensitivity of Kmean was calculated as 87.5% and the specificity was 91.3% for predicting local control (optimal threshold=0.30,AUC:0.924;95%CI:0.83-1.00). Conclusion Kmean value after radiotherapy is a potential biomarker for the early evaluation of clinical efficacy of radiotherapy in NPC patients.

Key words： Nasopharyngeal neoplasm/radiotherapy Diffusion-weighted imaging Diffusion kurtosis imaging

收稿日期: 2018-02-28

基金资助:

海南省自然科学基金面上项目(20168275);吴阶平基金(320.6750.17130);海南省卫生计生行业科研项目(1601320675A2002)

通讯作者: 林少民,Email:linshaomin1963@163.com

引用本文:

吴刚,黄薇园,王奋等. 高分辨率扩散加权成像对比扩散峰度成像在预测鼻咽癌放疗疗效中的应用[J]. 中华放射肿瘤学杂志, 2018, 27(7): 633-637.

Wu Gang,Huang Weiyuan,Wang Fen et al. Comparison of high-resolution diffusion-weighted imaging and diffusion kurtosis imaging for prediction of radiotherapy response in patients with nasopharyngeal carcinoma[J]. Chinese Journal of Radiation Oncology, 2018, 27(7): 633-637.

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http://journal12.magtechjournal.com/Jweb_fszlx/CN/10.3760/cma.j.issn.1004-4221.2018.07.002 或 http://journal12.magtechjournal.com/Jweb_fszlx/CN/Y2018/V27/I7/633

[1] Li H,Liu XW,Geng ZJ,et al. Diffusion-weighted imaging to differentiate metastatic from non-metastatic retropharyngeal lymph nodes in nasopharyngeal carcinoma[J].Dentomaxil Radiol,2015,44:20140126.
[2] Stadnik TW,Chaskis C,Michotte A,et al. Diffusion-weighted MR imaging of intracerebral masses:comparison with conventional MR imaging and histologic findings[J].Am. J Neuroradiol,2001,22(5):969-976.
[3] Zhang Y,Liu X,Zhang Y,et al. Prognostic value of the primary lesion apparent diffusion coefficient (ADC) in nasopharyngeal carcinoma:a retrospective study of 541 cases[J].Sci Rep,2015,5:12242.DOI:10.1038/srep12242.
[4] Valles FE,Perez-Valles CL,Regalado S,et al. Combined diffusion and perfusion MR imaging as biomarkers of prognosis in immunocompetent patients with primary central nervous system lymphoma[J].Am J Neuroradiol,2013,34(1):35-40.DOI:10.3174/ajnr. A3165.30.
[5] King AD,Chow KK,Yu KH,et al. Head and neck squamous cell carcinoma:diagnostic performance of diffusion-weighted MR imaging for the prediction of treatment response[J].Radiology,2013,266(2):531-538.DOI:10.1148/radiol.12120167.
[6] Zhao M,Liu Z,Sha Y,et al. Readout-segmented echo-planar imaging in the evaluation of sinonasal lesions:A comprehensive comparison of image quality in single-shot echo-planar imaging[J].Magn Reson Imag,2016,34(2):166-172.DOI:10.1016/j.mri.2015.10.010.
[7] Friedli I,Crowe LA,Viallon M,et al. Improvement of renal diffusion-weighted magnetic resonance imaging with readout-segmented echo-planar imaging at 3T[J].Magn Reson Imag,2015,33(6):701-708.DOI:10.1016/j.mri.2015.02.023.
[8] Hori M,Fukunaga I,Masutani Y,et al. Visualizing non-Gaussian diffusion:clinical application of q-space imaging and diffusional kurtosis imaging of the brain and spine[J]. Magn Reson Med Sci,2012,11(4):221-233.
[9] Jiang R,Jiang J,Zhao L,et al. Diffusion kurtosis imaging can efficiently assess the glioma grade and cellular proliferation[J]. Oncotarget,2015,6(39):42380-42393.DOI:10.18632/oncotarget.5675.
[10] Kamagata K,Tomiyama H,Hatano T,et al. A preliminary diffusional kurtosis imaging study of Parkinson disease:comparison with conventional diffusion tensor imaging[J]. Neuroradiology,2014,56(3):251-258.DOI:10.1007/s00234-014-1327-1.
[11] Yu XP,Hou J,Li FP,et al. Intravoxel incoherent motion diffusion weighted magnetic resonance imaging for differentiation between nasopharyngeal carcinoma and lymphoma at the primary site[J].J Comput Assist Tomogr,2016,40(3):413-418.DOI:10.1097/RCT.0000000000000391.
[12] Chen Y,Ren W,Zheng D,et al. Diffusion kurtosis imaging predicts neoadjuvant chemotherapy responses within 4 days in advanced nasopharyngeal carcinoma patients[J].J Magn Reson Imag,2015,42(5):1354-1361.DOI:10.1002/jmri.24910.
[13] Fujima N,Yoshida D,Sakashita T,et al. Prediction of the treatment outcome using intravoxel incoherent motion and diffusional kurtosis imaging in nasal or sinonasal squamous cell carcinoma patients[J].Eur Radiol,2017,27(3):956-965.DOI:10.1007/s00330-016-4440-1.
[14] Zong J,Lin S,Lin J,et al. Impact of intensity-modulated radiotherapy on nasopharyngeal carcinoma:Validation of the 7^th edition AJCC staging system[J]. Oral Oncol,2015,51(3):254-259.DOI:10.1016/j.oraloncology.2014.10.012.
[15] Lombardi M,Cascone T,Guenzi E,et al. Predictive value of prr-treatment apparent diffusion coefficient (ADC) in radio-chemiotherapy treated head and neck squamous cell carcinoma[J].Radiol Med,2017,122(5):345-352.DOI:10.1007/s11547-017-0733-y.
[16] Chen Y,Liu X,Zheng D,et al. Diffusion-weighted magnetic resonance imaging for early response assessment of chemoradiotherapy in patients with nasopharyngeal carcinoma[J].Magn Reson Imag,014,32(6):630-637.DOI:10.1016/j.mri.2014.02.009.
[17] Hong J,Yao Y,Zhang Y,et al. Value of magnetic resonance diffusion-weighted imaging for the prediction of radiosensitivity in nasopharyngeal carcinoma[J].Otolaryngol Head Neck Surg,2013,149(5):707-713. DOI:10.1177/0194599813496537.
[18] Huang WY,Wen JB,Wu G,et al. Diffusion-weighted imaging for predicting and monitoring primary central nervous system lymphoma treatment response[J].Am J Neuroradiol.2016,37(11):2010-2018.DOI:https://doi.org/10.3174/ajnr. A4867.
[19] Davnall F,Yip CS,Ljungqvist G,et al. Assessment of tumor heterogeneity:an emerging imaging tool for clinical practice?[J].Insig Imag,2012,3(6):573-589.DOI:10.1007/s13244-012-0196-6.
[20] Mardor Y,Roth Y,Ochershvilli A,et al. Pretreatment prediction of brain tumors’ response to radiation therapy using high b-value diffusion-weighted MRI[J].Neoplasia.2004,6(2):136-142.DOI:10.1593/neo.03349.
[21] Yu J,Xu Q,Song JC,et al. The value of diffusion kurtosis magnetic resonance imaging for assessing treatment response of neoadjuvant chemoradiotherapy in locally advanced rectal cancer[J].Eur Radiol.2017,27(5):1848-1857.DOI:10.1007/s00330-016-4529-6. Epub 2016 Sep 8.
[22] Yuan J,Yeung DK,Mok GS,et al. Non-Gaussian analysis of diffusion weighted imaging in head and neck at 3T:a pilot study in patients with nasopharyngeal carcinoma[J].PLoS One,2014,9(1):e87024.DOI:10.1371/journal.pone.0087024.eCollection 2014.
[23] Jambor I,Merisaari H,Taimen P,et al. Evaluation of different mathematical models for diffusion-weighted imaging of normal prostate and prostate Cancer using high b-values:a repeatability study[J].Magn Reson Med,2015,73(5):1988-1998.DOI:10.1002/mrm.25323.
[24] Harrison L,Blackwell K.Hypoxia and anemia:factors in decreased sensitivity to radiation therapy and chemotherapy?[J].Oncologist,2004,9(suppl 5):31-40.DOI:10.1634/theoncologist.9-90005-31.
[25] Zhu L,Pan Z,Ma Q,et al. Diffusion kurtosis imaging study of rectal adenocarcinoma associated with histopathologic prognostic factors:preliminary findings[J].Radiology,2017,284(1):66-76.DOI:10.1148/radiol.2016160094.
[26] Raja R,Sinha N,Saini J,et al. Assessment of tissue heterogeneity using diffusion tensor and diffusion kurtosis imaging for grading gliomas[J].Neuroradiology,2016,58(12):1217-1231.DOI:10.1007/s00234-016-1758-y.
[27] Marusyk A,Almendro V,Polyak K.Intra-tumour heterogeneity:a looking glass for cancer?[J].Nat Rev Cancer,2012,12(5):323-334.DOI:10.1038/nrc3261.