扩散加权成像对非手术喉癌和下咽癌患者同步放化疗前后的疗效评价

The value of diffusion-weighted imaging for clinical evaluation of chemoradiatiotherapy of non-surgical laryngeal and hypopharyngeal carcinoma patients

目的探讨磁共振扩散加权成像联合常规MRI检查评价非手术喉癌下咽癌同步放化疗疗效的应用价值。材料与方法搜集喉癌下咽癌患者(仅接受放化疗,未行手术治疗)共25例,全部病例均于患病局部活检或手术病理证实。所有患者治疗前均行常规MRI及扩散加权成像(DWI)扫描,分析患者MRI特点、测量肿瘤最大横截面积及表观扩散系数(ADC)值(包括平均ADC值、最低和最高ADC值);治疗后(放化疗结束后1个月内)再次行MRI检查,测残留肿瘤面积及ADC值,并计算肿瘤缓解率。分析治疗前及治疗后肿瘤ADC值与肿瘤缓解率相关性;分析治疗后完全缓解患者(CR组)与非完全缓解患者(非CR组)治疗前、后ADC值及变化的差异。结果 25例喉癌下咽癌患者治疗前肿瘤面积4.81(0.83~14.12)cm^2,治疗后肿瘤面积2.42(0~7.92)cm^2,肿瘤缓解率为74.8%(6.0%~100%),其中有11(11/25,44.0%)例患者治疗后肿瘤消失。治疗前肿瘤平均ADC值及最高ADC值与治疗后肿瘤缓解率呈负相关(r=–0.922、–0.691,P<0.05),治疗后平均ADC值与缓解率呈正相关(r=0.678,P<0.05);非CR组治疗前肿瘤平均、最高ADC值高于CR组,CR组治疗后平均ADC值及治疗前后平均ADC值的变化高于非CR组,差异有统计学意义(P值均<0.05)。结论治疗前肿瘤ADC值以及治疗前后肿瘤ADC值的变化对评价非手术喉癌下咽癌放化疗后早期缓解率有一定意义。

Objective： To investigate the value of the magnetic resonance diffusion weighted imaging combined with conventional MRI for predicting clinical effect of chemoradiotherapyin non-surgical laryngeal and hypopharyngeal carcinoma.Materials and Methods： A total of 25 cases of patients with non-surgical laryngeal and hypopharyngeal carcinoma, which was confirmed by biopsy or surgical pathology,were included. All patients underwent conventional MRI and DWI scan for pre- and post-treatment. The maximum cross sectional area and apparent diffusion coefficient（ADC） value（the mean, the highest and lowest ADC value） of the tumor were measured before treatment. The residual tumor size and ADC values were measured after treatment, and tumor regression rate was calculated. The differences of ADC values with complete response（CR） and non-CR before and after treatment were analyzed. Results： The maximum cross sectional area [2.42（0—7.92） cm^2] of the tumor after treatment was significantly reduced（P〈0.05） than that from pre-treatment[4.81（0.83—14.12） cm^2]. The total tumor remission rate was 74.8%（6.0%—100%）and CR was in 11（11/25, 44.0%） patients. Pre-treatment ADCmean and the highest ADC value were negatively correlated with the rate of tumor regression（r=-0.922,-0.691, P〈0.05）, and post-treatment ADCmean value was positively correlated with theregression rate（P〈0.05, r=0.678）. Pre-treatment ADCmean and ADChigh values in non CR group were higher than those in the CR group. Post-treatment ADCmean value and differences of the ADC value between pre- and post-treatment of CR group were significantly higher than those of non CR group（P〈0.05）. Conclusions： The pre-treatment ADC values and the differences of the ADC value between pre- and post-treatment might be useful to predict and evaluate the response of radiotherapy and chemotherapy in the non-surgical laryngeal and hypopharyngeal carcinoma patients.