表观扩散系数在非小细胞肺癌酪氨酸激酶抑制剂治疗效果评价中的应用

Apparent Diffusion Coefficient in Assessing Early Response to Tyrosine Kinase Inhibitors in Non-small Cell Lung Cancer

目的研究扩散加权成像(DWI)技术中表观扩散系数(ADC)值在非小细胞肺癌(NSCLC)应用酪氨酸激酶抑制剂(TKI)治疗效果评估中的价值。资料与方法前瞻性收集2014年5月-2015年12月经病理证实的19例拟接受TKI的晚期NSCLC患者,于靶向治疗前、治疗1周后以及治疗4周后进行3次CT及MRI扫描,比较不同时间点肿瘤长径、平均ADC值的变化;分析不同时间点肿瘤平均ADC值与肿瘤最大径及最大径变化率的相关性;比较有效组及无效组各个时间点ADC值组内及组间差异。用Bland-Altman分析法分析操作的可重复性。结果治疗1周后ADC值较治疗前显著增加(t=-6.329,P<0.05),而治疗1周后肿瘤最大径与治疗前差异无统计学意义(P>0.05)。与治疗前相比,治疗4周后ADC值明显升高(t=-4.878,P<0.05),肿瘤最大径与治疗前差异有统计学意义(t=7.054,P<0.05)。靶向治疗前肿瘤ADC值与治疗4周后的最大径变化率呈负相关(r^2=-0.474,P<0.05)。有效组内靶向治疗前与治疗1周后ADC值差异有统计学意义(P<0.05),治疗4周后有效组与无效组间ADC值差异有统计学意义(P<0.05)。Bland-Altman分析显示操作者间可重复性好。结论靶向治疗1周后的ADC值能较肿瘤最大径更敏感地反映肿瘤治疗后的改变,并且治疗前的ADC值在预测靶向治疗4周后的最大径变化趋势方面有一定的价值,具有可重复性。

Purpose To investigate the value of apparent diffusion coefficient （ADC） of diffusion weighted imaging （DWI） in the evaluation of the efficacy of treatment of non- small cell lung cancer （NSCLC） with tyrosine kinase inhibitor （TKI）. Materials and Methods Nineteen patients with advanced NSCLC who treated with TKIs from May 2014 to December 2015 were recruited prospectively. All patients underwent CT and MRI scans three times before targeted therapy, after 1 week and 4 weeks of treatment. The tumor maximal diameter and mean ADC value at different time points were compared. The correlations between mean ADC value and tumor maximal diameter and maximum diameter change rate at different time points were analyzed. Bland-Altman analysis was performed to confirm the reproducibility of measurements. Romdts The ADC value after l week of treatment was significantly increased compared with that before treatment （t= - 6.329, P〈0.05）, but the change of tumor maximal diameter was not significant （P〉0.05）. The ADC value was significantly increased after 4 weeks of treatment compared with that before treatment （t=-4.878, P〈0.05）, and the change of tumor maximal diameter was also significant （t=-7.054, P〈0.05）. The negative correlation was detected between the ADC before treatment and the maximal diameter change ratio after 4 weeks of treatment （r2=-0.474, P〈0.05）. In the group of responders, there was significant difference between the ADC value before treatment and 1 week after treatment （P〈0.05）. There was significant difference in ADC value between the groups of responders and non-responders alter 4 weeks of treatment （P〈0.05）. The Bland-Altman analysis showed good reproducibility among the operators. Conclusion The ADC value after 1 week of targeted therapy is more sensitive to the change of tumor than the maximal diameter, and the ADC value before treatment has a certain value in predicting the maximum diameters of the target after 4 weeks of targeted therapy with repeatability.