动态增强MRI对NSCLC放化疗疗效评价的研究

The Role of Dynamic Contrast-enhanced MRI for Evaluating Therapeutic Effect for NSCLC Patients with Chemotherapy or Chemoradiotherapy

目的探讨动态增强MRI在评价NSCLC放化疗疗效中的应用价值。方法20例患者22灶在治疗前后分别进行DCE-MRI成像,DCE-MRI成像采用3DLAVA技术,30秒一个时相,共11个时相。图像分析时将ROI放置在肿瘤强化最明显处,按照Schaefer的标准将时间信号强度曲线划分为A-D4种类型。比较治疗前后时间信号强度曲线类型差别及不同疗效组间最大增强比(MER)及首过斜率(slope)变化的差异。结果疗效较好组12灶,疗效不良组10灶。疗前与疗后时间信号强度曲线类型明显不同,疗前以A、B型曲线为主,疗后以B、C型曲线为主。疗效较好组slope变化较疗效不良组明显,分别为(-1.79±1.04)SI%/s,(-0.34±1.23)SI%/s。疗效较好组slope变化率明显大于疗效不良组,疗效较好组平均变化为(-61.06%±31.50)%,疗效不良组斜坡变化的中位值为-14.94%。疗效较好组MER变化值大于疗效不良组(p=0.043),疗效较好组平均变化-0.60±0.55,疗效不良组为-0.13±0.45。结论NSCLC治疗后可引起动态增强时间信号强度曲线类型的变化;不同疗效组间治疗前后首过斜率及最大增强比的变化程度上存在显著性差异,DCE-MRI能够反映NSCLC治疗相关的肿瘤血流动力学变化。

Objective To investigate the value of dynamic contrast-enhanced MRI for evaluating therapeutic effect for NSCLC patients with chemotherapy and/or radiotherapy. Methods Twenty consecutive patients with 22 lesions enrolled in this study, all of whom underwent DCE-MRI examinations pre- and post-treatment. DCE-MRI was acquired with 3D LAVA technique, 30 seconds per phase and total 11 phases were acquired. Region of interest was placed on the significantly enhanced area of the tumors. According to Scbaefer＇s standard, four types of time signal intensity curve （TIC） are classified, which areA, B, C and D, Types of TIC between pre- and post-treatment were compared （paired non-parameter）. And non-parameter test was used for comparison of slope and MER between responders and non-responders. Results There were 12 responders and 10 non-responders according to RECIST. Types of TIC shifted from A and B for pretreatment to B and C for post-treatment. Change of slope in responders was greater than that in non-responders, （-1.79±1.04） SI%/s, （- 0.34±1.23） SI%/s respectively. Change rate of slope in responders was greater than that in non-responders, （-61.06±31.50）% for responders,-14.94% （median） for non-responders. Change of MER in responders was greater than that in non-responders （p=0.043）, -0.60±0.55 and -0.13±0.45 respectively.Conclusion Types of TIC of DCE-MRI of NSCLCs often shifted after treatment. The amplitude of change of slope and MER after treatment was significantly greater in responders than in non-responders. DCE-MRI would be a promising tool for evaluating the hemodynamic change of tumors related to treatment.