体素内不相干运动成像对中老年直肠癌患者同步放化疗后骨髓抑制的评估价值

Value of intravoxel incoherent motion imaging in evaluating myelosuppression in middle-aged and elderly patients with rectal cancer after concurrent radiotherapy and chemotherapy

目的探讨体素内不相干运动(IVIM)成像对中老年直肠癌患者同步放化疗后骨髓抑制的评估价值。方法26例中老年局部进展期直肠癌患者按同步放化疗期间是否发生骨髓抑制分为正常组(15例)及骨髓抑制组(11例),分析两组间骨盆骨髓IVIM成像参数的差异。结果26例患者同步放化疗期间骨髓抑制分级0级为15例(57.7%)、1级为6例(23.1%)、2级为3例(11.5%)、3级为2例(7.7%)。骨髓抑制组同步放化疗前的灌注分数(f值)低于正常组(P<0.05),而两组标准表观扩散系数、双指数纯扩散系数值和灌注系数值同步放化疗前、后比较差异均无统计学意义(P>0.05)。ROC曲线分析结果显示,同步放化疗前f值预测患者骨髓抑制发生的AUC为0.82[95%CI(0.65~1.00)],当同步放化疗前f值为0.391时,预测骨髓抑制发生的灵敏度为80.00%,特异度为90.90%。结论同步放化疗前f值对中老年人局部进展期直肠癌放化疗期间骨髓抑制发生有一定预测价值。

Objective To explore the value of intravoxel incoherent motion(IVIM)imaging in evaluating myelosuppression in middle-aged and elderly patients with rectal cancer after concurrent radiotherapy and chemotherapy.Methods Twenty-six middle-aged and elderly patients with locally advanced rectal cancer underwent concurrent radiotherapy and chemotherapy,during which myelosuppression occurred in 11 cases(group A)and myelosuppression did not occur in 15 cases(group B).The differences of IVIM imaging parameters of pelvic bone marrow between the two groups were analyzed.Results During concurrent radiotherapy and chemotherapy,15 patients(57.7%)had grade 0 myelosuppression,6 patients(23.1%)had grade 1 myelosuppression,3 patients(11.5%)had grade 2 myelosuppression,and 2 patients(7.7%)had grade 3 myelosuppression.The perfusion fraction(f value)before concurrent radiotherapy and chemotherapy was lower in group A than that in group B(P<0.05),while the differences in standard apparent diffusion coefficient,double exponential pure diffusion coefficient,and perfusion coefficient before and after concurrent radiotherapy and chemotherapy were not significant between the two groups(P>0.05).ROC curve analysis showed that the AUC of f value in predicting the occurrence of myelosuppression in the patients before concurrent radiotherapy and chemotherapy was 0.82[95%CI(0.65-1.00)].When the f value before radiotherapy and chemotherapy was 0.391,the sensitivity and specificity of predicting the occurrence of myelosuppression were 80.00%and 90.90%,respectively.Conclusion The f value before concurrent radiotherapy and chemotherapy has a certain predictive value for the occurrence of myelosuppression during radiotherapy and chemotherapy in middle-aged and elderly patients with rectal cancer.