多b值弥散加权成像对非小细胞肺癌脑转移放射治疗的疗效分析价值

Value of efficacy analysis of multi-b value diffusion weighted imaging on non-small cell lung carcinoma brain metastasis radiotherapy

目的:探讨分析多b值磁共振成像(magnetic resonance imaging,MRI)弥散加权成像(diffusion-weighted imaging,DWI)在全脑放射治疗(以下简称放疗)(whole-brain radiotherapy,WBRT)联合立体定向消融放疗(stereotactic radiation therapy,SRT)治疗非小细胞肺癌(non-small cell lung carcinoma,NSCLC)脑转移瘤疗效评价中的价值和应用。方法:收集2017年2月至2019年2月于徐州医科大学附属宿迁医院进行WBRT联合SRT治疗的NSCLC脑转移患者46例,分别于放疗前1周和治疗后6个月行MRI功能成像扫描,根据扫描结果并参照实体瘤反应评价标准1.1版(Response Evaluation Criteria in Solid Tumors version 1.1,RECIST 1.1)标准进行评价,根据治疗结束后肿块最大直径的变化,将病例分为Ⅰ组有效组和Ⅱ组无效组。采用Kolmogorov-Smirnov检验对所有参数进行正态分布假设检验。符合正态分布的样本组间比较采用独立样本t检验,偏态分布的样本组间比较采用Kruskal-Wallis H检验,对两组的各项数值进行差异分析。应用受试者工作特征(receiver operator characteristic,ROC)曲线评估放疗前后瘤周区多b值表观弥散系数(apparent diffusion coefficient,ADC)的变化量在放疗疗效评价中的应用价值。结果:Ⅰ组瘤体区和瘤周区放疗6个月后的ADC平均值均明显高于放疗前1周,差异具有统计学意义(P<0.05)。Ⅱ组放疗前后瘤周区ADC的数值差异具有统计学意义(P<0.05),瘤体区的差异无统计学意义(P>0.05)。b=1000s/mm^(2)时瘤周区相应的ADC变化量对放疗疗效的评价最优。结论:在b=1000s/mm^(2)时DWI可以快速给出临床建议,为患者的疗效评估提供更好的依据,在NSCLC脑转移患者放疗后的临床应用中的价值值得进一步研究。

Objective:To study the value and application of analyzing multi-b-value magnetic resonance imaging(MRI)diffusion-weighted imaging(DWI)in the evaluation of the efficacy of whole-brain radiotherapy(WBRT)combined with stereotactic radiation therapy(SRT)in treatment of non-small cell lung carcinoma(NSCLC)brain metastases.Methods:Forty-six patients with NSCLC brain metastases treated with WBRT combined with SRT in Suqian Hospital Affiliated to Xuzhou Medical University between February 2017 and February 2019 were collected.MRI functional imaging scans were performed 1 week before radiotherapy and 6 months after treatment.The cases were evaluated according to the scan results and with reference to Response Evaluation Criteria in Solid Tumors version 1.1(RECIST1.1)criteria,and were divided into groupⅠ(effective group)and groupⅡ(ineffective group)according to the change in the maximum diameter of the tumor mass at the end of the treatment.The Kolmogorov-Smirnov test was used to test the hypothesis of normal distribution for all parameters.Between-group analysis was performed by independent sample t-test for normally distributed samples and Kruskal-Wallis H test for skewed samples to analyse the differences between the two groups.The receiver operator characteristic(ROC)curve was applied to assess the application value of the change in multiple b-value apparent diffusion coefficient(ADC)values in the peri-tumoral region before and after radiotherapy in the evaluation of the efficacy of radiotherapy.Results:In groupⅠ,the mean ADC values in both the tumour and peri-tumour areas 6 months after radiotherapy were significantly higher than that of 1 week before radiotherapy,and the difference was statistically significant(P<0.05).In groupⅡ,the difference of ADC values in the peri-tumoral area before and after radiotherapy was statistically significant(P<0.05),while the difference in the tumoral area was not statistically significant(P>0.05).The change in ADC values in the peri-tumoral area at b=1000 s/mm^(2) is the best for the efficacy evaluation of radiotherapy.Conclusion:DWI at b=1000 s/mm^(2) can give rapid clinical advice and provide a better basis for the assessment of patient outcomes,and its clinical application after radiotherapy in patients with NSCLC brain metastases deserves further study.