摘要
目的探讨3.0T磁共振体素内不相干性运动（IVIM）量化指标联合动态增强扫描的时间－信号强度曲线（TIC）在非小细胞肺癌（NSCLC）氩氦刀治疗后病灶残留早期诊断中的应用价值。方法收集100例行氩氦刀治疗的NSCLC患者，根据穿刺活检和随访结果将患者分为残留组（21例）和无残留组（79例）。比较两组患者治疗后7 d和1个月时的IVIM量化指标综合表观扩散系数（ADC）、慢速表观扩散系数（sADC）、快速表观扩散系数（fADC）、快速扩散所占容积分数（ffADC）及TIC类型的差异，采用受试者工作特征（ROC）曲线分析评估量化指标的诊断效能，并确定最佳界值。计算TIC类型作为诊断标准时的灵敏度和特异度。评估IVIM量化指标联合TIC类型对病灶残留早期诊断的效力，并与磁共振常规扫描和扩散加权成像（DWI）序列进行比较。结果治疗后7 d和1个月时，残留组和无残留组间ADC、sADC和ffADC差异有统计学意义（均P〈0.05），其中sADC和ffADC诊断氩氦刀治疗后病灶残留的效果较好。治疗后7 d时，sADC和ffADC诊断氩氦刀治疗后病灶残留的AUC分别为0.861和0.895，灵敏度分别为81.0%和90.5%，特异度分别为77.2%和73.4%。治疗后1个月时，AUC分别为0.836和0.883，灵敏度分别为100.0%和76.2%，特异度分别为58.2%和89.9%。以Ⅱ＋Ⅲ型TIC为局部病灶残留诊断标准的诊断效果最好，治疗后7 d时的灵敏度和特异度分别为80.9%和58.2%，治疗后1个月时的灵敏度和特异度分别为85.7%和62.0%。治疗后7 d时，IVIM指标联合TIC类型的灵敏度和特异度分别为97.5%和85.7%；治疗后1个月时，IVIM指标联合TIC类型的灵敏度和特异度分别为97.5%和90.5%。IVIM量化指标联合TIC类型的诊断性能优于磁共振常规扫描和DWI。结论应用IVIM量化指标结合TIC类型可以对NSCLC氩氦刀治疗后的病灶残留进行早期精确诊断，效果优于磁共振常规扫描和DWI。
ObjectiveTo study the application of intravoxel incoherent motion （IVIM） quantitative index combined with time-signal intensity curve （TIC） of dynamic contrast enhanced 3.0T magnetic resonance in the early precise diagnosis of residual lesions in non-small cell lung cancer （NSCLC） after argon-helium cryosurgery.MethodsOne hundred NSCLC patients who underwent argon-helium cryosurgery were collected and divided into the residual group （21 cases） and non-residual group （79 cases） according to the result of needle biopsy and follow-up. The apparent diffusion coefficient （ADC）, slow apparent diffusion coefficient （sADC）, fast apparent diffusion coefficient （fADC）, fraction of fast apparent diffusion coefficient （ffADC） and TIC type of IVIM quantitative index between the two groups were compared at 7 days and 1 month after argon-helium cryosurgery, respectively. The diagnosis performance of each quantitative index was analyzed by receiver operating characteristic （ROC） curve and the best cut-off value was computed. The specificity and sensitivity of TIC types were calculated as diagnostic criteria. The diagnosis performance of IVIM quantitative index combined with TIC type was evaluated and compared with the conventional MRI and DWI.ResultsThe differences of ADC, sADC and ffADC at 7 days and 1 month after argon-helium cryosurgery between the residual group and non-residual group were statistically significant （all P〈0.05）, in which the diagnosis performance of sADC and ffADC were better. The AUC of sADC and ffADC at 7 days after argon-helium cryosurgery were 0.861 and 0.895, the sensitivity were 81.0% and 90.5%, and the specificity were 77.2% and 73.4%, respectively. The AUC of sADC and ffADC at 1 month after argon-helium cryosurgery were 0.836 and 0.883, the sensitivity were 100.0% and 76.2%, and the specificity were 58.2% and 89.9%, respectively. The diagnosis performance of TIC type Ⅱ＆Ⅲ was best. The sensitivity and specificity were 80.9% and 58.2% at 7 days after treatment, 85.7% and 62.0% at 1 month after treatment, respectively. At 7 days after treatment, the sensitivity and specificity of IVIM combined with TIC were 97.5% and 85.7%, while at 1 month after treatment, the sensitivity and specificity of IVIM combined with TIC were 97.5% and 90.5%, respectively. The diagnosis performance of IVIM quantitative index combined with TIC type was better than conventional MRI and DWI.ConclusionThe combination of IVIM quantitative index and TIC type can be used in the early diagnosis of residual lesions after argon-helium cryosurgery for NSCLC, whose effect is better than conventional MRI and DWI.
作者
宗登伟
郭晨阳
黎海亮
程洪涛
胡鸿涛
肖金成
Zong Dengwei;Guo Chenyang;Li Hailiang;Cheng Hongtao;Hu Hongtao;Xiao Jincheng(Department of Radiology,HeNan Cancer Hospital（Affiliated Cancer Hospital of Zhengzhou University）,Zhengzhou 450000,China)
出处
《中华肿瘤杂志》
CAS
CSCD
北大核心
2018年第11期851-856,共6页
Chinese Journal of Oncology
基金
国家自然科学基金面上项目（81372370）
关键词
癌
非小细胞肺
氩氦刀
磁共振
体素内不相于运动
时间-信号强度曲线
Carcinoma
non-small cell lung
Argon-helium cryosurgery
Magnetic resonance
Intravoxel incoherent motion
Time-signal intensity curve
