磁共振多参数成像对局部进展期直肠癌新辅助放化疗效果的评估价值

Evaluation Value of Multi-parameter Magnetic Resonance Imaging for the Efficacy of Neoadjuvant Radiotherapy and Chemotherapy in Locally Advanced Rectal Cancer

目的探究磁共振多参数成像对局部进展期直肠癌新辅助放化疗效果的评估价值。方法选取2021年6月至2023年6月安阳市中医院收治的98例局部进展期直肠癌患者的临床资料开展回顾性分析,根据新辅助放化疗效果分为完全缓解(CR)组(35例)与未完全缓解(nCR)组(63例)。比较两组MRI多参数[表观弥散系数(ADC)、血浆交换率、组织灌注量、转置常数],分析MRI多参数与局部进展期直肠癌新辅助放化疗效果的关系,通过受试者工作特征(ROC)曲线分析MRI多参数评估局部进展期直肠癌新辅助放化疗效果的价值。结果治疗前CR组ADC、治疗后转置常数均低于nCR组,治疗后ADC、治疗前血浆交换率、治疗前转置常数、治疗前组织灌注量均高于nCR组(P<0.05)。二元logistic回归分析显示,ADC差值、血浆交换率差值、转置常数差值、组织灌注量差值均是疗效的相关影响因素(P<0.05)。ROC曲线分析显示,ADC差值、血浆交换率差值、转置常数差值、组织灌注量差值评估局部进展期直肠癌新辅助放化疗效果的曲线下面积(AUC)分别为0.941、0.742、0.953、0.774,敏感度、特异度分别为88.6%/87.3%、88.6%/50.8%、97.1%/82.5%、77.1%/68.3%。ADC差值、血浆交换率差值、转置常数差值、组织灌注量差值联合评估局部进展期直肠癌新辅助放化疗效果的AUC为0.993,敏感度、特异度为91.4%、100.0%。结论MRI多参数(ADC、血浆交换率、组织灌注量、转置常数)差值评估局部进展期直肠癌新辅助放化疗效果均具有一定价值,且联合评估价值更高。

Objective To explore the evaluation value of multi-parameter magnetic resonance imaging for the efficacy of neoadjuvant radiotherapy and chemotherapy in locally advanced rectal cancer.Methods Clinical data of 98 patients with locally advanced rectal cancer admitted to Anyang Traditional Chinese Medicine Hospital from June 2021 to June 2023 were retrospectively analyzed,and the patients were divided into CR group(35 cases)and non-CR group(63 cases)according to the efficacy of neoadjuvant chemoradiotherapy.The MRI parameters[apparent diffusion coefficient(ADC),plasma exchange rate,tissue perfusion volume,transposition constant]were compared,and the correlation between MRI multiple parameters and the efficacy of neoadjuvant chemoradiotherapy in locally advanced rectal cancer was analyzed.And the value of MRI multiparametric assessment of the effect of neoadjuvant radiochemotherapy in locally progressive rectal cancer was analyzed by receiver operating characteristic(ROC)curves.Results The ADC before treatment and post-treatment transposition constant in the CR group were lower than those in the nCR group,while post-treatment ADC,pre-treatment plasma exchange rate,pre-treatment transposition constant and pre-treatment tissue perfusion were higher than those in the nCR group(P<0.05).Binary logistic regression analysis showed that ADC difference,plasma exchange rate difference,transposition constant difference and tissue perfusion volume difference were all related influencing factors of therapeutic efficacy(P<0.05).The area under the curve(AUC)for evaluating the efficacy of neoadjuvant radiotherapy and chemotherapy in locally advanced rectal cancer using ADC difference,plasma exchange rate difference,transposition constant difference and tissue perfusion difference were 0.941,0.742,0.953,and 0.774,respectively.The sensitivity and specificity were 88.6%/87.3%,88.6%/50.8%,97.1%/82.5%,77.1%/68.3%,respectively.The AUC of the combined evaluation of ADC difference,plasma exchange rate difference,transposition constant difference and tissue perfusion difference for the efficacy of neoadjuvant radiotherapy and chemotherapy in locally advanced rectal cancer was 0.993,with sensitivity and specificity of 91.4%and 100.0%,respectively.Conclusion MRI multi-parameter(ADC,plasma exchange rate,tissue perfusion volume,transposition constant)differential evaluation of neoadjuvant chemotherapy for locally advanced rectal cancer has certain value,and the combined evaluation has higher value.