DCE-MRI及DWI在评估靶向治疗NSCLC疗效中的应用价值

Application of DCE-MRI and DWI in evaluating the efficacy of targeted therapy in patients with NSCLC

目的:探讨动态对比增强磁共振成像(DCE-MRI)及扩散加权成像(DWI)在评估靶向治疗非小细胞肺癌(NSCLC)疗效中的应用价值。方法:回顾性分析2017年5月至2019年5月收治的经病理组织学确诊的72例NSCLC患者的病例资料,所有患者均进行了靶向治疗,靶向治疗前、治疗3个月后均进行DCE-MRI、DWI和CT检查。以实体瘤疗效评价标准1.1(RECIST1.1)结果作为金标准,将患者分为有效组(n=41)和无效组(n=31),分别评估DCE-MRI、DWI疗效判断正确率以及比较2组DCE参数和ADC值的差异。结果:DCE-MRI和DWI疗效判断正确率分别为87.50%、72.22%,有效预测值分别为90.00%、78.38%,无效预测值分别为84.38%、65.71%,Kappa值分别为0.75、0.44;治疗前后,有效组的SLOPE、MER、WR均高于同期无效组,且治疗后与本组治疗前比较差异有统计学意义;无效组治疗后SLOPE和WR水平低于治疗前;有效组ADC值高于本组治疗前且高于无效组(P<0.05)。结论:DCE-MRI在评估靶向治疗NSCLC患者疗效方面,与实体瘤疗效评价标准1.1的一致性较好,正确率较高。

Objective:To explore the application value of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI)and diffusion-weighted imaging(DWI)in evaluating the efficacy of targeted therapy for non-small cell lung cancer(NSCLC).Methods:The clinical data of 72 patients with NSCLC diagnosed by pathological biopsy from May 2017 to May 2019 were retrospectively analyzed.All patients received DCE-MRI,DWI and CT before and after targeted therapy.The patients were divided into effective group(n=41)and ineffective group(n=31)according to the results of RECIST1.1.The diagnostic accuracy of DCE-MRI and DWI were compared with the results of RECIST1.1.The difference of parameter of DCE-MRI and DWI in the 2 groups were compared.Results:The accuracy of evaluating the efficacy of targeted therapy of DCE-MRI and DWI was 87.50%and 72.22%,the effective predictive value was 90.00%and 78.38%,the invalid predictive value was 84.38%and 65.71%,and the Kappa value was 0.75 and 0.44 respectively.Before and after treatment,the SLOPE,MER and WR of the effective group were higher than those of the ineffective group,and above data after treatment was statistically different with those before treatment(P<0.05).The SLOPE and WR levels of the ineffective group after treatment were lower than those before treatment(P<0.05).The ADC value of the effective group after treatment was higher than that before treatment and higher than that of the ineffective group(P<0.05).Conclusion:DCE-MRI in evaluation of the efficacy of targeted therapy in patients with NSCLC has good consistency with the result of RECIST1.1,and has good accuracy.