磁共振弥散加权成像对中晚期食管癌放化疗疗效的评估价值

The Value of Magnetic Resonance Diffusion Weighted Imaging in Evaluating the Efficacy of Radiotherapy and Chemotherapy for Advanced Esophageal Cancer

目的探讨磁共振弥散加权成像技术在中晚期食管癌放化疗疗效中的评估价值。方法随机纳入2021年9月至2022年12月期间在南阳市中心医院行根治性放化疗的32例中晚期食管癌患者,于放化疗前后实施MRI及DWI扫描,根据实体肿瘤疗效评价结果分为缓解组和未缓解组,比较两组放化疗前后ADC值、肿瘤最大径、ADC值变化率及肿瘤最大径变化率有无差异。计量资料比较采用t检验,使用ROC曲线分析各参数对于中晚期食管癌患者放化疗疗效的评估价值。结果共32例接受放化疗的中晚期食管癌患者,缓解组25例,未缓解组7例。放化疗前,缓解组的ADC值、ADC值变化率大于未缓解组,但差异无统计学意义(P>0.05);放化疗结束后,缓解组的ADC值高于未缓解组,肿瘤最大径小于未缓解组,差异有统计学意义(P<0.05);所有患者治疗后的ADC值均较治疗前增高,差异有统计学意义(P<0.05)。ROC曲线分析显示,放化疗后的ADC值达到2.540×10^(-3)/(mm^(2)·s^(-1))时为最佳阈值,此时可以诊断食管癌患者在放化疗后达到缓解,其敏感度为72.0%,特异度为71.4%,ROC曲线下面积为0.791。结论磁共振弥散加权成像对评估中晚期食管癌患者放化疗效果有重要价值,其中放化疗后的ADC值可较为精准地预测其疗效。

Objective To investigate the predictive value of magnetic resonance diffusion weighted imaging in the efficacy of radiotherapy and chemotherapy for advanced esophageal cancer.Methods A total of 32 patients with advanced esophageal cancer who underwent radical chemoradiotherapy in Nanyang Central Hospital from September 2021 to December 2022 were randomly included.MRI and DWI scans were performed before and after chemoradiotherapy.According to the evaluation results of solid tumor efficacy,they were divided into remission group and non-remission group.The ADC value,maximum tumor diameter,ADC value change rate and maximum tumor diameter change rate before and after chemoradiotherapy were compared between the two groups.The t test is used on the measurement data,and the value of each parameter in evaluating the efficacy of radiotherapy and chemotherapy for advanced esophageal cancer was analyzed by ROC curve.Results A total of 32 patients with advanced esophageal cancer received chemoradiotherapy,including 25 in the remission group and 7 in the non-remission group.Before chemoradiotherapy,the ADC value and ADC change rate of the remission group were higher than those of the non-remission group,but the difference was not statistically significant(P>0.05).After chemoradiotherapy,the ADC value of the remission group was higher than that of the non-remission group,and the maximum diameter of the tumor was smaller than that of the non-remission group(P<0.05).The ADC values of all patients after treatment were higher than those before treatment and the difference was statistically significant(P<0.05).ROC curve showed that when ADC value was 2.540×10^(-3)/(mm^(2)·s^(-1))after radiotherapy and chemotherapy,it was the best threshold.At this time,patients with esophageal cancer could be diagnosed as remission after radiotherapy and chemotherapy.The sensitivity was 72.0%,the specificity was 71.4%,and the area under the ROC curve was 0.791.Conclusion Magnetic resonance diffusion weighted imaging is of great value in evaluating the efficacy of radiotherapy and chemotherapy in patients with advanced esophageal cancer.The ADC value after radiotherapy and chemotherapy can accurately predict its efficacy.