定量DCE-MRI对鼻咽癌化放疗疗效评估的价值

The Evaluation of the Efficacy of Chemoradiotherapy of Nasopharyngeal Carcinoma with Quantitative DCE-MRI

目的探讨鼻咽癌化放疗前后动态对比增强磁共振成像(DCE-MRI)定量参数(K^(trans)、K_(ep)及V_e)值的变化情况,从功能学角度评估鼻咽癌化放疗疗效。方法搜集本院2014年10月至2016年1月经病理证实的鼻咽癌初诊患者26例,分别于治疗前和诱导化疗加放疗50 Gy后行常规及DCE-MRI检查,应用后处理软件测量感兴趣区的DCE-MRI定量参数值。采用独立样本t检验,对治疗前肿瘤区和健侧翼外肌的DCE-MRI定量参数进行比较;采用配对样本t检验,对治疗前和诱导化疗加放疗50 Gy后肿瘤区DCE-MRI定量参数进行比较。采用Pearson方法分析治疗前鼻咽癌DCE-MRI各定量参数与诱导化疗加放疗50 Gy后肿瘤消退率的相关性。结果治疗前鼻咽癌肿瘤区的K^(trans)、K_(ep)及V_e值均高于健侧翼外肌,且差异有统计学意义。ROC曲线分析结果显示:在鉴别鼻咽癌肿瘤区与健侧翼外肌时,K^(trans)诊断效能最大。诱导化疗加放疗50 Gy后肿瘤的K^(trans)和K_(ep)值降低,而V_e值升高,且与治疗前的差异均有统计学意义。治疗前K^(trans)、K_(ep)值与肿瘤消退率呈正相关,r值分别为0.544、0.395,治疗前V_e与肿瘤消退率无明显相关性。结论定量DCE-MRI能够从功能学角度量化评估鼻咽癌化放疗疗效,且治疗前的K^(trans)、K_(ep)对预测鼻咽癌对化放疗的敏感性有价值,其中K^(trans)较好。

Objective To study the changes of the DCE-MRI quantitative parameters（ K^（trans）,K_（ep）and V_e） before and after chemoradiotherapy of nasopharyngeal,and to evaluate the effect of radiotherapy of nasopharyngeal carcinoma from a functional perspective. Methods Twenty-six patients with nasopharyngeal carcinoma（ NPC） proven by pathology in our hospital from October 2014 to January 2016 were collected. They underwent quantitative DCE-MRI pretreatment and induction chemotherapy plus 50 Gy radiotherapy. Quantitative parameters（ K^（trans）、K_（ep）and V_e） we obtained. Independent sample t test was used to compare the quantitative parameters（ K^（trans）、K_（ep）and V_e） between the tumor area and normal lateral pterygoid muscle. Paired sample t test was used to compare pretreatment quantitative parameters values and post-treatment. Pearson method was used to analyze the correlation of pretreatment nasopharyngeal carcinoma quantitative parameters（ K^（trans）、K_（ep） and V_e） and the tumor regression rate. Results On pretreatment images,the tumor area K^（trans）,K_（ep）and V_ewere higher than the normal lateral pterygoid muscle,and the differences were statistically significant. ROC curve analysis results showed that in the differential diagnosis of nasopharyngeal tumor area and normal lateral pterygoid muscle,K^（trans）was the best parameter. After Induction chemotherapy plus 50 Gy radiotherapy,the tumor K^（trans）and K_（ep）reduced,and V_eincreased,the differences between pretreatment and post-treatment parameters were statistically significant. Pretreatment K^（trans）,K_（ep） and Induction chemotherapy plus 50 Gy radiotherapy tumor regression rate was positively correlated,and the correlation coefficient r values were 0. 544,0. 395,respectively. There was no significant correlation between the pretreatment V_eand tumor regression rate. Conclusion DCE-MRI can quantitatively assess the efficacy of nasopharyngeal carcinoma chemoradiotherapy from a functional perspective. Pretreatment K^（trans）,K_（ep）can predict the value of the efficacy of nasopharyngeal carcinoma chemoradiotherapy to some extent and K^（trans）was the better parameter.