MR Resolve-IVIM成像对IIb期以上宫颈鳞癌同期放化疗疗效评价的初步研究

A Preliminary Study of MR Resolve-IVIM Imaging in the Efficacy Evaluation of Concurrent Chemo-radiotherapy for Cervical Squamous Cancer (Stage ≥IIb)

目的:初步探讨MR Resolve-IVIM成像对IIb期以上宫颈鳞癌同期放化疗疗效评价的意义。方法:对30例经病理证实的宫颈鳞癌患者在治疗前1周内、同期放化疗(CCRT)后1周、CCRT后4周行MR检查(包括MRI常规序列和Resolve-IVIM)。由两名高年资医师分别测量肿瘤最大径、ADC值(b=1000s/mm^(2))、计算IVIM参数(纯扩散系数D值、伪扩散系数D*值和灌注分数f)。根据RECIST标准评价肿瘤的疗效,按照疗效分组对ADC值、D值、D*值和f进行统计学分析。结果:30例患者CCRT后完全缓解(CR)22例,部分缓解(PR)8例,无进展和稳定病例。CR组肿瘤的ADC值、D值在CCRT后明显升高(CCRT前、CCRT后1周、CCRT后4周分别为0.72±0.12×10^(-3)mm^(2)/s、1.06±0.97×10^(-3)mm^(2)/s、1.27±0.15×10^(-3)mm^(2)/s;0.92±0.37×10^(-3)mm^(2)/s、1.35±0.32×10^(-3)mm^(2)/s、1.58±0.30×10^(-3)mm^(2)/s),各个时间点的差异有统计学意义;D*值在CCRT前、CCRT后1周、CCRT后4周缓慢升高(分别为19.69±18.8×10^(-3)mm^(2)/s、26.60±18.13×10^(-3)mm^(2)/s、29.18±19.51×10^(-3)mm^(2)/s),其差异无统计学意义;f值在CCRT前、CCRT后1周、CCRT后4周先升后降(分别为11.60±5.53%、26.68±6.66%、24.73±4.31%),治疗前与治疗后1周、4周差异有统计学意义。PR组肿瘤的ADC值、D值在CCRT后亦明显升高(CCRT前、CCRT后1周、CCRT后4周分别为0.79±0.93×10^(-3)mm^(2)/s、1.04±0.34×10^(-3)mm^(2)/s、1.36±0.13×10^(-3)mm^(2)/s;0.78±0.80×10^(-3)mm^(2)/s、1.27±0.16×10^(-3)mm^(2)/s、1.46±0.13×10^(-3)mm^(2)/s),各个时间点的差异有统计学意义;D*值在CCRT前、后缓慢升高(分别为16.61±6.74×10^(-3)mm^(2)/s、21.95±8.75×10^(-3)mm^(2)/s、23.19±7.72×10^(-3)mm^(2)/s),其差异无统计学意义;f值在CCRT前、CCRT后1周、CCRT后4周先升后降(分别为10.35±1.95%、22.99±5.27%、21.57±3.03%),治疗前与治疗后1周、4周差异有统计学意义。结论:MR Resolve-IVIM成像无论是图像质量还是定量参数分析均有助于IIb期以上宫颈鳞癌同期放化疗的疗效评价。

Objective:To explored the significance of MR Resolve-IVIM imaging in the efficacy evaluation of concurrent chemo-radiotherapy for cervical squamous cancer(stage ≥IIb).Methods:At the time of before chemo-radiotherapy, 1 week and 4 weeks after treatment, MRI examinations including conventional MRI scan and Resolve-IVIM, were carried out in 30 patients with pathologically confirmed cervical squamous cancer. Two senior physicians independently measured the tumor’s maximum diameter and ADC value(b=1000 s/mm^(2)), and calculated the IVIM parameters, containing pure diffusion coefficient(D) and pseudo-diffusion coefficient(D*) and perfusion fraction(f). Grouped those cases according to the RECIST standard, the ADC value, D, D *and f were statistically analyzed.Results:After concurrent chemoradiotherapy, 22 patients had complete remission(CR), and 8 patients had partial remission(PR). In the CR group, ADC and D values increased significantly after CCRT(0.72±0.12×10^(-3)mm^(2)/s, 1.06±0.97×10^(-3)mm^(2)/s, 1.27±0.15×10^(-3)mm^(2)/s;0.92±0.37×10^(-3)mm^(2)/s, 1.35±0.32×10^(-3)mm^(2)/s, 1.58±0.30×10^(-3)mm^(2)/s), the differences at each time point were statistically significant;D* was slowly raised before and after CCRT(19.69±18.8×10^(-3)mm^(2)/s, 26.60±18.13×10^(-3)mm^(2)/s, 29.18±19.51×10^(-3)mm^(2)/s);f value was increased in 1 week after CCRT and decreased in 4 weeks after CCRT(11.60±5.53%, 26.68±6.66%, 24.73±4.31%). ADC values and D of the tumor in the PR group also increased significantly after CCRT(0.79±0.93×10^(-3)mm^(2)/s, 1.04±0.34×10^(-3)mm^(2)/s, 1.36±0.13×10^(-3)mm^(2)/s;0.78±0.80×10^(-3)mm^(2)/s, 1.27±0.16×10^(-3)mm^(2)/s, 1.46±0.13×10^(-3)mm^(2)/s), the differences between the various time-points were statistically significant;D* values were slowly increased after treatment(16.61±6.74×10^(-3)mm^(2)/s, 21.95±8.75×10^(-3)mm^(2)/s, 23.19±7.72×10^(-3)mm^(2)/s);the change trend of f value was the same as that of the CR group.Conclusion:MR Resolve-IVIM imaging, whether image quality or quantitative parameter analysis, was helpful to evaluate the efficacy of concurrent chemo-radiotherapy of cervical squamous cancer.