IVIM-DWI与DCE-MRI定量参数对宫颈鳞癌同步放化疗早期疗效预测的价值

Predictive value of IVIM-DWI and DCE-MRI quantitative parameters on the early efficacy of concurrent chemoradiotherapy for cervical squamous cell carcinoma

目的研究体素内不相干运动扩散加权成像(IVIM-DWI)与动态增强MRI(DCE-MRI)在宫颈鳞癌同步放化疗(CCRT)早期疗效预测中的应用价值。方法纳入50例经病理证实的宫颈鳞癌患者,于CCRT前行IVIM-DWI和DCE-MRI扫描,测量所有患者治疗前IVIM-DWI定量参数ADC、D、D*、f及DCE-MRI定量参数Ktrans、Kep、Ve、Vp的值。并于CCRT结束后1个月行MRI复查,根据肿瘤缓解情况分为治愈组和残留组。对两组治疗前IVIM-DWI和DCE-MRI各参数进行比较。并通过绘制受试者工作特性(ROC)曲线找到最佳预测参数及其预测阈值。结果治愈组24例,残留组26例。治愈组治疗前的ADC、D和Ve值明显低于残留组(均P<0.05),f值和Ktrans值明显高于残留组(均P<0.05)。其他参数均相近(均P>0.05)。D的ROC曲线下面积(AUC=0.823)最大,其次是Ktrans(AUC=0.754),D与Ktrans的联合预测效能(AUC=0.867)高于D、Ktrans单独预测,其敏感性分别为88.5%、85.8%、88.8%,特异性分别为70.8%、66.7%、79.2%。结论治疗前IVIM-DWI与DCE-MRI的定量参数对宫颈鳞癌CCRT早期疗效具有一定的预测价值,其中D值的预测效能最佳,D与Ktrans的联合应用可提高预测效能。

Objective To evaluate the application value of intravoxel incoherent motion diffusion weighted imaging(IVIM-DWI)and dynamic contrast enhancement MRI(DCE-MRI)in the prediction of the early efficacy of concurrent chemoradiotherapy(CCRT)for cervical squamous cell carcinoma.Methods Fifty patients with cervical squamous cell carcinoma confirmed by pathology were included.Before CCRT,IVIM-DWI and DCE-MRI were scanned,and the values of quantitative parameters including ADC,D,D*and f of IVIM-DWI and Ktrans,Kep,Ve and Vp of DCE-MRI before treatment were measured for all patients.MRI reexamination was performed 1 month after the end of CCRT,and all patients were divided into the cure group and the residual group according to the tumor remission.The parameters of IVIM-DWI and DCE-MRI before treatment were statistically compared between two groups.The optimal predictive parameters and predictive thresholds were determined by drawing the receiver operating characteristic(ROC)curve.Results Twenty-four patients were assigned into the cure group and twenty-six patients in the residual group.The ADC,D and Ve values before treatment in the cure group were significantly lower than those in the residual group(all P<0.05),whereas the f and Ktrans values were significantly higher than those in the residual group(both P<0.05).The other parameters did not significantly differ between two groups(all P>0.05).The area under ROC curve(AUC=0.823)of D value was the largest,followed by Ktransvalue(AUC=0.754).The combined prediction efficacy of D and Ktrans(AUC=0.867)was higher than that of either D or Ktrans alone.The sensitivity was 88.5%,85.8%and 88.8%,and the specificity was 70.8%,66.7%and 79.2%,respectively.Conclusions Quantitative parameters of IVIM-DWI and DCE-MRI before treatment have certain predictive value for the early efficacy of CCRT in cervical squamous cell carcinoma,among which the predictive efficacy of D value is the highest,and the combined application of D and Ktrans can improve the predictive efficacy.