多层螺旋CT联合弥散加权成像评价胃癌新辅助化疗疗效的价值

Value of MSCT combined with DWI in evaluating efficacy of neoadjuvant chemotherapy for gastric cancer

目的探讨多层螺旋CT(MSCT)联合弥散加权成像(DWI)评价胃癌新辅助化疗疗效的价值。方法选择拟行新辅助化疗的150例胃癌患者,化疗前后均行MSCT和DWI检查;比较不同病理学反应、疗效患者肿瘤体积减少率、肿瘤最长径减少率、治疗前后肿瘤实质部分Slow表观扩散系数(ADC)值差值(ΔADC);采用受试者工作特征(ROC)曲线分析其预测胃癌新辅助化疗疗效的价值。结果新辅助化疗第1、2、3周期肿瘤体积、肿瘤最长径小于化疗前(P均<0.05),ADC大于化疗前(P<0.05)。病理完全缓解(pCR)者肿瘤体积减少率、肿瘤最长径减少率、ΔADC大于未病理完全缓解(NpCR)者(P均<0.05),有效者肿瘤体积减少率、肿瘤最长径减少率、ΔADC大于无效者(P均<0.05)。肿瘤体积减少率、肿瘤最长径减少率、ΔADC、联合三项指标预测新辅助化疗pCR、疗效的曲线下面积(AUC)分别为0.719(95%CI:0.599~0.838)、0.702(95%CI:0.603~0.801)、0.817(95%CI:0.733~0.900)、0.872(95%CI:0.796~0.947);0.784(95%CI:0.705~0.863)、0.725(95%CI:0.643~0.807)、0.735(95%CI:0.644~0.825)、0.929(95%CI:0.882~0.977),高于肿瘤体积减少率、肿瘤最长径减少率、ΔADC单独预测(P均<0.05)。结论MSCT联合DWI可准确评估胃癌新辅助化疗病理学反应以及疗效,有助于指导临床个体化新辅助化疗。

Objective To investigate the value of multi-slice spiral CT(MSCT)combined with diffusion-weighted imaging(DWI)in evaluating the efficacy of neoadjuvant chemotherapy for gastric cancer.Methods Totally 150 patients with gastric cancer were selected to receive neoadjuvant chemotherapy.MSCT and DWI were performed before and after chemotherapy.We compared the tumor volume reduction rate,reduction rate in the longest tumor diameter and Slow appar⁃ent diffusion coefficient(ADC)value difference(ΔADC)before and after treatment among patients with different pathological reactions and efficacy.We used receiver operating characteristic(ROC)curve to analyze its value in predicting the ef⁃ficacy of neoadjuvant chemotherapy for gastric cancer.Results Tumor volumes and the longest tumor diameters at cycles 1,2 and 3 after neoadjuvant chemotherapy were smaller than those before chemotherapy(P<0.05),and ADC was larger than that before chemotherapy(P<0.05).Tumor volume reduction rate,reduction rate in the longest tumor diameter,ΔADC were greater in the pathologic complete response(pCR)patients than in the non-pCR(NpCR)ones(all P<0.05),tumor volume reduction rate,reduction rate in the longest tumor diameter,andΔADC were greater in the effective group than in the invalid group(all P<0.05).The area under the curve(AUC)of tumor volume reduction rate,reduction rate in the longest tumor diameter,ΔADC,and the three indicators combined in predicting the neoadjuvant chemotherapy pCR and efficacy were 0.719(95%CI:0.599-0.838),0.702(95%CI:0.603-0.801),0.817(95%CI:0.733-0.900),0.872(95%CI:0.796-0.947),0.784(95%CI:0.705-0.863),0.725(95%CI:0.643-0.807),0.735(95%CI:0.644-0.825),and 0.929(95%CI:0.882-0.977),which were higher than that of each alone(all P<0.05).Conclusion MSCT combined with DWI can accurately evaluate the pathological response and efficacy of neoadjuvant chemotherapy for gastric cancer,which is helpful to guide clinical personalized neoadjuvant chemotherapy.