表观弥散系数在肝脏转移癌化学治疗疗效评价中的意义

Role of Apparent Diffusion Coefficients in Assessment of Response to Chemotherapy in Liver Metastasis Patients

目的研究表观弥散系数(apparent diffusion coefficients,ADC)在临床消化道肿瘤肝脏转移癌化学治疗疗效判断中的作用。方法选取2006年4月至2007年4月期间北京大学人民医院胃肠外科收治的消化道肿瘤肝转移患者10例,其中结直肠癌肝转移患者8例,胃癌肝转移及食管癌肝转移各1例;所有患者均进行化学治疗。具体方案为:8例结直肠癌肝转移患者中4例行FOLFOX6、3例行XELOX、1例行FOLFIRI,胃癌肝转移者行ECF,食管癌肝转移者行DCF;应用GE MEDICAL SYSTEMS HD EXCITE 1.5 T在行化学治疗之前和之后1个月进行磁共振弥散加权成像(duffusion weight i maging,DWI)扫描,测定ADC值;实体瘤疗效评价标准(re-sponse evaluation criteria in solid tumors,RECIST)评价肿瘤化疗疗效。结果化学治疗前ADC值低于9.04×10-4mm2/s的肝转移癌的疗效明显好于ADC值高于9.04×10-4mm2/s的肝转移癌;对化学治疗有效的肝转移癌(6/10)治疗前的ADC值明显低于对化学治疗无效的肝转移癌(4/10),P=0.033;肝转移癌患者行化学治疗后1个月,ADC值升高的肝转移癌对化学治疗敏感。结论化学治疗前ADC值低的肝转移癌对化学治疗敏感;化学治疗后ADC值增高的肝转移癌对化学治疗敏感。

Objective To evaluate the role of apparent diffusion coefficients（ADC） in assesment of response to chemotherapy in patients with gastrointestinal liver metastasis.Methods Ten patients with liver metastasis（8 from colorectal cancer,1 from gastric cancer,1 from esophageal cancer） at Peking University People＇s Hospital from April 2006 to April 2007 were included.All of them received chemotherapy（FOLFOX6： 4 cases,XELOX： 3 cases,and FOLFIRI： 1 case in 8 cases of colorectal liver metastases;ECF： 1 case of gastric liver metastases;DCF： 1 case of esophageal liver metastasis）.ADC were calculated after MR duffusion-weight imaging exmination（GE MEDICAL SYSTEMS HD EXCITE 1.5 T） 1 month pre-and post-chemotherapy,respectively.Tumour response to chemotherapy was assessed by RECIST criteria.Results Tumors with low pretreatment ADC（9.04×10-4 mm2/s） responded better to chemotherapy than that with high ADC（9.04×10-4 mm2/s）;pretreatment ADC of cases（6/10） were remarkable lower than those of cases（4/10）,P=0.033.Increased ADC after one-month chemotherapy in patients with liver metastasis predicted a better response.Conclusions Low pretreatment ADC is predictive of better response to chemotherapy.An increased ADC after treatment predicts a better response to chemotherapy.