MRI在评价韧带样纤维瘤病疗效中的价值

The value of MRI in evaluating the therapeutic effect of desmoid-type fibromatosis

目的探讨MRI在不同疗效的韧带样纤维瘤病(DF)中的信号变化特征。方法回顾性分析北京大学肿瘤医院2008至2015年经病理证实的术后复发DF患者124例的MRI资料,MRI资料包括确诊复发后发病部位的基线MRI图像,至少每半年随访1次MRI,随访满3年且有第3年末的MRI扫描图像。采用基于肿瘤大小的实体瘤疗效评价标准(RECIST)评价其疗效,将患者分为进展(PD)、缓解(PR)、稳定(SD)组。采用单因素方差分析、Kruskal-Wallis或χ2检验比较PD、SD和PR组中特征的差异,多重比较采用Bonferronei校正P值,采用Spearsman相关系数检验信号评分与肿瘤最大径的相关性。结果PD组17例、SD组37例、PR组70例。3组间患者年龄、性别分布和部位的差异无统计学意义(P>0.05),治疗方案的差异有统计学意义(P<0.05),3组患者的基线检查病灶最大径和末次检查最大径的差异也有统计学意义(P均<0.05)。PD、SD和PR组的T2基线评分、T1基线增强评分差异均无统计学意义(P均>0.05),3组的末次随访MRI图像的T2评分、T2评分变化、末次T1增强评分和T1增强评分变化的差异均有统计学意义(P均<0.05)。末次随访时,肿瘤最大径与T2评分呈中度正相关(r=0.434,P<0.01),肿瘤最大径与T1增强评分呈强正相关(r=0.743,P<0.01)。结论MRI在评价韧带样纤维瘤病的疗效方面具有价值。

Objective To compare the characteristics of MRI signals in different therapeutic effect of desmoid-type fibromatosis(DF).Methods One hundred and twenty-four DF patients with pathologically proven postoperative recurrent lesions from Peking University Cancer Hospital from 2008 to 2015 were enrolled in the study.All patients had baseline MRI scans,followed by once MRI scan at least every six months,and the follow-up period was three years.All patients had MRI images at the end of the third year.The therapeutic effect was evaluated by response evaluation criteria in solid tumors(RECIST)criteria,and the patients were divided into three groups:progressive disease(PD),stable disease(SD)and partial response(PR).Differences in features in the PD,SD,and PR groups were compared using one-way analysis of variance,Kruskal-Wallis,or Chi-square test.Multiple comparisons were performed using Bonferroni to correct P values.The spearman correlation coefficient was used to test the correlation between signal score and tumor maximum diameter.Results Among the 124 patients,17 experienced PD,37 exhibited SD and 70 exhibited PR.There were no significant differences in age,gender distribution and the location of lesion among three groups(P>0.05).The difference of treatment strategies was statistically significant(P<0.05).The difference of tumor maximum diameter of baseline and the last follow-up MRI scan was also statistically significant between three groups(P<0.05).There was no significant differences in T2 scores and enhancement scores of baseline MRI scan among the PD,SD,and PR groups(P>0.05).At the last follow-up MRI scan,the T2 signal scores,the changes of T2 signal,the scores of enhancement and the changes of enhancement of the PD,SD,and PR groups were significantly different among three groups(P<0.05).At the last follow-up MRI scan,the tumor maximum diameter was positively correlated with the score of T2 signal(r=0.434,P<0.01),and the tumor maximum diameter was positively correlated with the score of enhancement(r=0.743,P<0.01).Conclusion MRI has great value in evaluating the therapeutic effect of DF.