MRI-DWI对进展期食管癌新辅助化疗早期疗效评价的临床研究

Clinical study on MRI-DWI for early therapeutic evaluation in neoadjuvant chemotherapy of progressive stage esophageal carcinoma

目的探讨核磁共振弥散加权成像(MRI-DWI)对进展期食管癌新辅助化疗早期疗效评估。方法选取该院2018年8月至2020年3月收治的食管癌患者60例为研究对象,经胃镜获取病理活检明确诊断为食管鳞癌或腺癌。2~3个周期新辅助化疗后行根治性食管癌切除术+区域淋巴结清扫术,化疗前后分别进行MRI-DWI检查,观察所有患者化疗前后表观弥散系数(ADC)的变化,以及在病理、影像学分组条件下ADC的变化。结果最终有51例患者纳入研究。影像学标准疗效评价有效率为41.18%(21/51),病理标准疗效评价有效率为62.74%(32/51),比较差异有统计学意义(P=0.047)。所有患者原发病灶与区域淋巴结靶病灶化疗前ADC值分别为(1.54±0.25)×10^(-3)、(1.61±0.40)×10^(-3) mm^(2)/s,化疗后分别为(2.14±0.38)×10^(-3)、(2.32±0.36)×10^(-3) mm^(2)/s,比较差异有统计学意义(P<0.05)。原发病灶和区域淋巴结靶病灶病理反应组的ADC值均高于病理无反应组(P<0.05);区域淋巴结靶病灶影像反应组ADC值高于影像无反应组,但两组差异无统计学意义(P=0.630)。原发病灶病理反应组ADC最高(P=0.030)。结论化疗可影响食管癌ADC值,通过检测ADC值的变化能较早地对近期疗效进行预测。

Objective To investigate the early effect evalluation of MRI diffusion-weighted imaging(DWI)in neoadjuvant chemotherapy for progressive stage esophageal cancer.Methods Sixty patients with esophageal cancer treated in this hospital from August 2018 to March 2020 were selected as the study subjects and definitely diagnosed as esophageal squamous cancer or adenocarcinoma by gastroendoscopic pathological biopsy.After 2-3 cycles of neoadjuvant chemotherapy,the radical esophageal cancer excision+regional lymph node dissection was performed.The MRI-DWI examination was performed before and after chemotherapy.The changes of apparent dispersion coefficient(ADC)in all patients were observed before and after chemotherapy.The ADC changes under the condition of pathological and imaging grouping were also observed.Results Fifty-one cases were finally included into the study.The treatment effective rate evaluated by imageological standard was 41.18%(21/51),which by pathological standard was 62.74%(32/51),and the difference between them was statistically significant(P=0.047).The ADC values of primary lesions and regional lymph nodes target lesions before chemotherapy in all patients were(1.54±0.25)×10^(-3) and(1.61±0.40)×10^(-3) mm^(2)/s respectively,which were(2.14±0.38)×10^(-3) and(2.32±0.36)×10^(-3) mm^(2)/s after chmotherpay,and the differences were statistically significant(P<0.05).The ADC value of primary lesion and regional lymph node target lesions in the pathogenic response group were higher than those in the pathological non-response group(P<0.05).The ADC values of regional lymph nodes target lesions in the imageological response group were higher than those in the imageological non-response group,but the difference between these two groups had no statistical significance(P=0.630).The ADC value of primary lesions in the pathological response group was the highest(P=0.030).Conclusion Chemotherapy can affect the ADC value in esophageal cancer.Detecting the change of ADC values can early predict the short term treatment effect.