3.0T磁共振弥散加权成像评价食管癌同步放化疗疗效

3.0T diffusion weighted imaging in evaluating the efficacy of concurrent chemoraidotherapy in patients with esophageal carcinoma

目的探讨磁共振弥散加权成像（DWI）对食管癌同步放化疗疗效预测和价值的评估。方法46例食管癌患者均在同步放化疗前，放化疗结束后1-3个月接受3．0T磁共振DWI检查，根据食管病变及转移淋巴结高信号是否完全消失分为A组（高信号完全消失），B组（高信号始终未完全消失）。测量患者同步放化疗前后食管病变长度变化、正常组织与病变组织的表观弥散系数（ADC）值变化。根据磁共振DWI区分食管病变是否侵犯周围组织或器官，以及病变长度分为T1-3组（未受侵袭）及T4两组（受侵袭），分析两组病变ADC值之间的差异；在磁共振DWI图像对纵隔淋巴结进行判定，并根据其有无转移分为N0组（无转移）和N1组（有转移），对两组食管病变ADC值之间的差异进行分析。结果同步放化疗后食管病变长度明显短于同步放化疗前，经比较差异有统计学意义。A、B组放化疗前、后ADC值均明显低于食管正常组织。各组放化疗后ADC值均较放化疗前明显增加。A组放化疗后ADC；值明显高于B组。T1-3组、T4组患者ADC值差异无统计学意义。N0组A13C值明显高于N1组，经比较差异有统计学意义。结论同步放化疗可使食管病变明显变小；放化疗后食管恶性病变组织ADC值明显升高，提示ADC值可与形态学改变之前较早，较准确地反映肿瘤内部代谢变化及对同步放化疗的反应。

Objective To explore the value of 3.0T diffusion weighted imaging （DWI） in predicating and evaluating the efficacy of concurrent chemoraidotherapy （CCRT） in esophageal carcinoma. Methods A total of 46 patients with esophageal carcinoma were divided into group A （with complete disappearance of high signal intensity） and group B （with incomplete disappearance of high signal intensity） based on the complete disappearance of high signal intensity of esophageal lesion and metastatic lymph node after 1 to 3 months of CCRT so as to measure the changes of esophageal lesion length and apparent diffusion coefficient （ADC） value of normal and lesion tissues, and were divided into T1-3 group （without affection） and T4 group （with affection） to analyze the differentiation of ADC values in both groups, according to the affection of esophageal lesion to sur- rounding tissues and organs distinguished by DWI. Additionally, all patients were divided into No group （without metastasis） and N1 group （with metastasis） on the basis of metastasis of mediastinum lymph node determined by DWI, so as to analyze the differentiation of ADC values in both groups. Results After CCRT, esophageal lesion length decreased evidently than treatment before and the difference was statistically significant. ADC values in groups A and B were obviously lower than that in the esophageal normal tissues before and after treatment, while ADC value increased markedly in all groups after treatment compared with the treatment before, and ADC value was apparently higher in group A than that in group B. However, there was no significant difference between TI- 3 and T4 groups. Moreover, No group was obviously higher than N1 group in ADC value,and the difference was significant. Conclusion CCRT can obviously shorten esophageal lesion and increase ADC value in malignant lesion tissues of tumor, which suggested that ADC value can reflect the internal metabolism changes and concurrent chemoraidotherapy of tumor earlier and more accurately.