MR扩散加权成像联合肿瘤指标对子宫颈癌放化疗疗效的评估

Evaluation of MR diffusion weighted imaging combined with tumor markers in efficacy of chemoradiotherapy for cervical cancer

目的探讨扩散加权成像(diffusion weighted imaging,DWI)、表观扩散系数(apparent diffusion coefficient,ADC)以及肿瘤指标[癌胚抗原(carcinoembryonic antigen,CEA)、糖类抗原125(carbohydrate antigen125,CA-125)、CA-153及细胞角蛋白19片段(cytokerati-19-fragment,CYFRA21-1)]对中晚期子宫颈癌放化疗后疗效评估的应用价值。方法对39例经病理证实为>ⅡB期的中晚期子宫颈癌患者分别于放化疗前、中及后期随访复查行盆腔MR扫描,包括T1WI、T2WI、DWI及增强扫描,分别测量治疗前、后肿瘤最大径,并分别测量横断位及矢状位肿瘤最大径平面的平均ADC值,并检测放化疗前、后的肿瘤指标。结果子宫颈癌患者放化疗治疗后与治疗前比较,ADC值升高[(1.388±0.948)×10^-3mm^2/s vs(0.885±0.086)×10^-3mm^2/s],肿瘤最大径缩小[(2.2±0.4)cm vs(4.5±1.9)cm],差异均具有统计学意义(均P<0.01)。治疗前各项肿瘤指标升高组ADC值均较正常组高,差异均具有统计学意义(均P<0.05)。放化疗前肿瘤指标升高者,治疗后肿瘤指标均降低(均P<0.05)。CYFRA21-1升高组肿瘤最大径小于正常组,差异具有统计学意义(P=0.01)。结论弥散加权成像中的ADC值联合肿瘤指标可以监测子宫颈癌放化疗疗效。

Objective To investigate the evaluation value of diffusion weighted imaging(DWI),apparent diffusion coefficient(ADC)and tumor markers[carcinoembryonic antigen(CEA),carbohydrate antigen 125(CA-125),CA-153 and cytokerati-19-fragment(CYFRA21-1)]on the efficacy of chemoradiotherapy for cervical cancer.Methods Thirty-nine patients with advanced cervical cancer who were pathologically proved to be above the stageⅡB were examined for pelvic MRI,including T1 WI,T2 WI,DWI,and enhanced scanning.The maximum diameter of tumor was measured before and after treatment,the average ADC values were obtained by measuring in the transverse and sagittal planes of tumor maximum diameter,and the tumor indexes were detected before and after chemoradiotherapy.Results For patients with cervical cancer after chemoradiotherapy,the ADC value increased significantly[(1.388±0.948)×10^-3 mm^2/s vs(0.885±0.086)×10^-3 mm^2/s],and the maximum diameter of tumor decreased significantly[(2.2±0.4)cm vs(4.5±1.9)cm],with statistically significant difference(both P<0.01).Before treatment,the ADC value of the group with increased tumor indexes was higher than that of the normal group,and the difference was statistically significant(all P<0.05).In the patients with elevated tumor indexes before chemoradiotherapy,the tumor indexes decreased after treatment(all P<0.05).The maximum tumor diameter of the CYFRA21-1 increased group was smaller than that of the normal group,and the difference was statistically significant(P=0.01).Conclusion The ADC value combined with tumor markers can monitor the efficacy of chemoradiotherapy for cervical cancer.