DEC-MRI半定量对肺癌同步放化疗敏感性的预测价值

Value of DCE-MRI Semi-quantification in Predicting the Sensitivity of Lung Cancer to Concurrent Chemoradiotherapy

【目的】探讨多期动态增强磁共振成像(DCE-MRI)半定量对肺癌患者同步放化疗敏感性的预测意义及其与肿瘤消退率的关系。【方法】选取本院收治的83例拟行同步放化疗的肺癌患者,应用DCE-MRI扫描分析其半定量参数与肿瘤消退率、放化疗敏感性预测的关系,并观察DCE-MRI图像的成像质量情况。【结果】DCE-MRI成像质量3级、2级、1级、0级分别为61例(74.50%),20例(24.09%)、2例(2.41%)、0例。ROC曲线分析显示,以治疗前Ve=0.20为临界值,预测同步放化疗敏感性的敏感度为84.6%、特异度83.9%、准确性80.4%,曲线下面积为0.846。治疗1个月后43例治疗敏感(敏感组),40例治疗不敏感(不敏感组),敏感组TTP、SERmax值与不敏感组比较,差异均有统计学意义(P<0.05);两组PEI、MSI、MSD值比较,差异无统计学意义(P>0.05)。肺癌患者治疗前DCE-MRI半定量参数Ktrans与肿瘤消退率呈正相关(r=0.421,P=0.014),Ve与肿瘤消退率呈负相关(r=-0.881,P=0.000),治疗前Ktrans值越高,Ve越低,患者对同步放化疗越敏感。【结论】DCE-MRI半定量参数预测肺癌放化疗敏感性价值较高,其图像质量效果比较好,可以通过指导化疗药物的选用达到预测最终的疗效,值得被广泛应用。

【Objective】To investigate the value of DCE-MRI semi-quantification in predicting the sensitivity of patients w让h lung cancer to concurrent chemoradiotherapy and relationship with tumor regression rate.【Methods】A total of 83 lung cancer patients who underwent concurrent chemoradiotherapy in our hospital were selected.EX2E-MRI scan was used to analyze the relationship of semi-quantitative parameters with tumor regression rate and chemoradiotherapy sensitivity prediction.The imaging quality of EX2E-MRI images were also observed in this study.【Results】The DCE-MRI image quality showed that there were 61 cases(74.50%),20 cases(24.09%),2 cases(2.41%),and 0 cases in grade 3,2,1 and 0,irrespectively.The sensitivity,specificity and accuracy of concurrent chemoradiotherapy sensitivity prediction by DEE-MRI were 84.6%,83.9% and 80.4%,irrespectively,based on the ROC curve analysis(Ve=0.20).After 1 month of treatment,there were 43 cases in the sensitive group and 40 cases in the insensitive group.The TTP value in the sensitive group was lower than that in the insensitive group,while the SERmax value in the sensitive group was significantly higher than that in the insensitive group;the difference was statistically significant(P<0.05).The values of PET,MSI and MSD in the two groups were not significantly different(P>0.05).The tumor area decreased gradually after radiotherapy and chemotherapy;and the tumor area at 3 months after treatment was(7.23±3.01)cm^2,which was significantly lower than that before radiotherapy and chemotherapy,while the tumor regression rate presented a gradually increasing trend,the difference was statistically significant(P<0.05).Ktrans,a semi-quantitative parameter of DCE-MRI,was positively correlated with tumor regression rate in lung cancer patients before treatment(r=0.421,P=0.014),and Ve was negatively correlated with tumor regression rate(r=-0.881=0.000).Patients who had higher value of Ktrans before treatment showed lower value of Ve,indicating more sensitive to concurrent chemoradiotherapy.【Conclusion】DCE-MRI semi-quantitative parameter analysis shows a high value in predicting the sensitivity of radiotherapy and chemotherapy for lung cancer.The image quality is also good.Thus it can guide the selection of chemotherapy drugs to achieve the final curative effect,which is worthy of wide application.