MRI增强三期扫描在肺癌非手术治疗疗效评价中的初步研究

Preliminary Assessing of No-surgical Treatment Response in Bronchogenic Carcinoma with Three-phase Contrast Material-enhanced Magnetic Resonance Imaging

目的:初步探讨MRI增强三期扫描在评价周围型肺癌非手术治疗疗效中的作用。方法:对32例周围型肺癌患者行MRI增强三期扫描,分别在25、120、180 s行胸部扫描,记录肺癌增强前后各时相的信号值并计算强化净增值、最大强化率,与文献结果进行对照,记录120、180 s时肺癌的强化模式。结果:治疗后周围型肺癌平扫信号值、增强后120 s及180 s的信号值分别是(478±108)、(926±209)、(1 050±252)。强化净增殖(571±225)、最大强化率(119±49)明显低于文献报道的未经治疗的肺癌强化净增殖(655)(t=2.178,P=0.005<0.05)及最大强化率(150)(t=4.196,P=0.001<0.05)。32例中6例在180 s时表现为均匀强化,6例中4例在120 s时表现为不均匀强化,1例表现为均匀强化,1例表现为周边强化。结论:治疗后肺癌有逐渐强化的趋势;MRI增强三期扫描能够反映肺癌的血流动力学信息,是评价肺癌非手术治疗疗效的有效方法。

Objective To evaluate the efficacy of three-phase contrast material-enhanced magnetic resonance imaging（MRI） in assessing no-surgical treatment response in peripheral bronchogenic carcinoma preliminarily.Methods 22 Patients with bronchogenic carcinoma after no-surgical treatment underwent three-phase contrast material-enhanced magnetic resonance imaging.Three scans were obtained at 25,120 and 180 seconds respectively after nonionic contrast material was administrated via the antecubital vein at a rate of 2mL/sec by using an autoinjector.Precontrast and postcontrast signal intensity on every scan was recorded.Peak Height（PH） and Maximum Enhancement（Emax） were calculated.Enhancement pattern was evaluated on the images obtained at 120 and 180 seconds after injection of contrast medium.Results Precontrast signal intensity,postcontrast signal intensity at 120 and 180 seconds were 478±108,926±209 and 1050±252.PH（571±225）and Emax（119±49）of bronchogenic carcinoma after no-surgical treatment were significantly lower than those of bronchogenic carcinoma without any therapy（mean PH 655,mean Emax 150）（t=2.178,p=0.0050.05,t=4.196,p=0.0010.05）.6 cases among 22 appeared homogeneous enhancement at 180 seconds.At 120 seconds,there were 4 cases with inhomogeneous enhancement,1 case with homogeneous enhancement,1 case with peripheral enhancement among the 6 cases.Conclusion Bronchogenic carcinoma after no-surgical treatment shows a gradual increase to the peak height after administration of contrast material.Three-phase contrast material-enhanced magnetic resonance imaging can reflect the blood supply of bronchogenic carcinoma and might be an effective approach for evaluation of no-surgical treatment response in bronchogenic carcinoma.