IVIM-DWI及3D-pCASL在局部晚期鼻咽癌诱导化疗近期疗效预测中的应用研究

Application of IVIM⁃DWI and 3D⁃pCASL in Predicting the Early Response of Induction Chemotherapy for Locally Advanced Nasopharyngeal Carcinoma

目的探讨体素内不相干运动扩散加权成像(IVIM-DWI)及三维伪连续动脉自旋标记(3D-pCASL)技术定量参数在局部晚期鼻咽癌(LANPC)诱导化疗(IC)近期疗效中的预测价值。方法搜集2020年12月至2021年12月经病理活检证实的Ⅲ~Ⅳa期鼻咽癌(NPC)患者53例,均行IC,于治疗前行IVIM-DWI及3D-pCASL扫描,IVIM参数包括:真实扩散系数(D)、灌注相关扩散系数(D^(*))、灌注分数(f);3D-pCASL参数包括血流量平均值(BF_(mean))、血流量最小值(BF_(min))、血流量最大值(BF_(max))。所有患者治疗前后均行常规MRI平扫+增强扫描。根据实体肿瘤疗效评估标准(RECIST 1.1)分为完全缓解组(CR)(n=25)和非完全缓解组(nCR)(n=28)。比较两组间各参数的差异,对有统计学意义的参数绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC)。结果CR组治疗前D值较nCR组低(P<0.001),CR组治疗前BF_(mean)值及BF_(max)值较nCR组高(P均<0.001),其余各参数均无统计学意义。D值、BF_(mean)值、BF_(max)值及联合指标新预测因子(PRE)预测LANPC IC近期疗效的AUC分别为0.811、0.867、0.877及0.907。结论IVIM-DWI与3D-pCASL作为无创性功能磁共振技术可对LANPC患者IC近期疗效进行预测,对于指导临床进行个体化治疗具有较大意义。

Objective To investigate the predictive value of quantitative parameters of intravoxel incoherent motion dif⁃fusion⁃weighted imaging(IVIM⁃DWI)and three⁃dimensional pseudo⁃continuous arterial spin labeling(3D⁃pCASL)in the early response of induction chemotherapy in locally advanced nasopharyngeal carcinoma(LANPC).Methods A total of 53 patients with stageⅢ⁃Ⅳa nasopharyngeal carcinoma confirmed by pathological biopsy from December 2020 to December 2021 were collected,all received induction chemotherapy,and underwent IVIM⁃DWI and 3D⁃pCASL scans before treatment.IVIM parameters included:true diffusion coefficient(D),perfusion⁃related diffusion coefficient(D∗),perfusion fraction(f);3D⁃pCASL parameters include mean blood flow(BF_(mean)),minimum blood flow(BF_(min)),and maximum blood flow(BF_(max)).All patients underwent routine MRI scan plus enhanced examination before and after treatment.According to the Response Evaluation Criteria in Solid Tumors(RECIST 1.1),they were divided into complete remission(CR)group(n=25)and non⁃complete remission(nCR)group(n=28).The differences of the parameters between the two groups were compared,and the receiver operating characteristic(ROC)curve was drawn for the parameters with statistical significance,and the area under the curve(AUC)was calculated.Results The D value of the CR group before treatment was lower than that of the nCR group(P<0.001),and the BF_(mean)and BF_(max)of the CR group before treatment were higher than those of the nCR group(all P<0.001),and the other parameters were not statistically significant.The AUC of D value,BF_(mean)value,BF_(max)value and combined index PRE for predicting the early response of induction chemotherapy for LANPC were 0.811,0.867,0.877 and 0.907 respectively.Conclusion IVIM⁃DWI and 3D⁃pCASL as non⁃invasive functional MRI tech⁃niques can predict the early response of induction chemotherapy for LANPC,which is of great significance for guiding clini⁃cal individualized treatment.