摘要
目的探讨MRI动态增强扫描(DCE-MRI)预测鼻咽癌同步放化疗敏感性的价值。方法 2009年10月至2012年6月经本院鼻咽镜活检病理证实并行同步放化疗的鼻咽癌患者共63例。所有患者于治疗前行DCEMRI,测量肿瘤平均、高强化区及低强化区时间信号强度曲线及半定量参数,包括达峰时间(TTP)、正性增强积分(PEI)、最大上升斜率(MSI)、最大下降斜率(MSD)。于放疗50 Gy再次行MR检查,依据肿瘤消退率(RS0-50)分为治疗敏感组、疗效中间组及治疗抗拒组。分析治疗前肿瘤DCE-MRI参数与RS0-50的相关性及其预测治疗敏感及抗拒的价值。结果与消退率具有统计学意义相关性的参数包括:治疗前肿瘤平均、高强化区及低强化区的曲线类型、TTP及MSD,r=-0.646^-0.746、-0.667^-0.681及0.281~0.301;平均MSI、低强化区MSI及高强化区PEI,r=0.287、0.372及-0.254。受试者工作特征曲线(ROC)分析显示以肿瘤低强化区TTP<70 s为阈值预测肿瘤治疗敏感,其敏感性、特异性、阳性预测值、阴性预测值及准确性分别为100%、56.9%、36.3%、100%及65.1%;以肿瘤平均TTP>70 s为阈值预测肿瘤治疗抗拒,其敏感性、特异性、阳性预测值、阴性预测值及准确性分别为100%、80.4%、54.5%、100%及84.1%。结论 DCE-MRI半定量参数能够较好地预测鼻咽癌治疗后消退情况与治疗敏感性,有望为鼻咽癌个体化治疗提供依据。
Objective To investigate the value of dynamic contrast enhanced magnetic resonance imaging （DCE MRI） performed before treatment in predicting the sensitivity of nasopharyngeal carcinoma to concurrent chemoradiation. Methods During the period from October 2009 to June 2012 at authors＇ hospital, concurrent chemoradiation therapy was carried out in 63 patients with pathologically proved nasopharyngeal carcinoma. Pretreatment DCE MRI was performed in all patients. The time-signal intensity curve （TIC） and semiquantitative parameters of the mean and high enhanced areas aswell as the low enhanced areas, including time to peak （TTP）, positive enhancement integral （ PEI）, maximum slop of increase （MSI） and maximum slop of decrease （MSD） were measured. After receiving 50Gy dose, the patient was reexam- ined with DCE MRI. According to the tumor regression rate （RS0 50） the patients were divided into sensitive therapeutic effect group, moderate therapeutic effect group and resistant therapeutic effect group. The correlations between pretreatmentDCE MRI parameters and the tumor regression rate were analyzed, and their values in predicting sensitive and resistant therapeutic effect were estimated. Results The semiquantitative parameters, that carried certain statistically significant correlations with the tumor regression rate, included TIC, TTP and MSD of the pretreatment mean and high enhanced areasas well as the low enhanced areas （ r = - 0. 646 to - 0. 746, r = - 0. 667 to - 0. 681 and r = 0.281 - 0. 301, respectively）, the mean MSI of tumor, MSI of low enhanced areas （r =0.287 and r =0. 372, respectively） and PEI of tumor high enhance areas （r = - 0. 254）. ROC analysis showed that when setting 〈 70s as the threshold of TIP at tumor low enhanced area the predicting sensitive therapeutic effect, the specificity, sensitivity, positive predictive value （PPV）, nega-rive predictive value （NPV） and accuracy was 100%, 56.9% , 36.3% , 100% and 65.1% respectively, and when setting 〉 70s as the threshold of TTP the predicting resistant therapeutic effect, the specificity, sensitivity, PPV, NPV and accuracy was 100%, 80.4%, 54.5% , 100% and 84.1% respectively. Conclusion Pretreatrnent semiquantitative parameters of DCE MRI can well predict tumor regression rate and sensitivity to concurrent chemoradiation in nasopharyngeal carcinoma, It is hopeful that these parameters of DCE MRI may become a useful reference in making clinical individualized therapeutic scheme.
出处
《临床放射学杂志》
CSCD
北大核心
2014年第5期689-694,共6页
Journal of Clinical Radiology
关键词
鼻咽癌
磁共振成像
同步放化疗
敏感性
Nasopharyngeal carcinoma
Magnetic resonance imaging
Concurrent chemoradiation
Sensitivity
