影像科学与光化学 ›› 2019, Vol. 37 ›› Issue (4): 362-370.DOI: 10.7517/issn.1674-0475.190511

• 综述与论文 • 上一篇    下一篇

DWMRI对周围型非小细胞癌放化疗疗效的评估作用

赵宏, 张专昌   

  1. 青岛市市立医院东院区放射科, 山东 青岛 266071
  • 收稿日期:2019-05-09 出版日期:2019-07-15 发布日期:2019-07-15
  • 通讯作者: 张专昌

Evaluation of Radiotherapy and Chemotherapy in Peripheral Non-small Cell Carcinoma by DWMRI

ZHAO Hong, ZHANG Zhuanchang   

  1. Qingdao Municipal Hospital, Qingdao 266071, Shandong, P. R. china
  • Received:2019-05-09 Online:2019-07-15 Published:2019-07-15

摘要: 本文探究了磁共振弥散加权成像(diffusion-weighted magnetic resonance imaging,DWMRI)对周围型非小细胞癌(NSCLC)的诊断意义及放化疗疗效的评估作用。选取2016年1月~2019年1月于我院就诊的NSCLC患者100例,放疗处方剂量46~66 Gy,单次剂量2.0~2.2 Gy,每日放疗1次,每周5次,并配合化疗治疗。放化疗前后应用CT与DWMRI观察放化疗前后近期疗效、DWMRI高信号表达、表观扩散系数(apparent diffusion coefficient,ADC)值变化以及影响预后的因素。研究结果显示,CT与MRI图像评价放疗前后100例NSCLC患者中,CR组28例,PR组53例,NR组19例(PD 2例,SD 17例),治疗有效率为81.00%,CR组和PR组患者1、2、3年无进展生存率分别为89.29%、46.42%、39.28%和56.60%、37.74%、33.97%,差异具有统计学意义(χ2=24.500,P=0.000)。放疗后肺癌原发灶DWMRI高信号消失35例,未消失65例;淋巴结高信号完全消失者40例,未完全消失者35例;肺癌原发灶、淋巴结完全消失者18例,未完全消失者29例。两组NSCLC患者1、2、3年无进展生存率分别为71.25%、34.52%、25.00%与35.64%、4.50%、4.50%,差异具有统计学意义(χ2=25.790,P=0.000)。原发灶与转移淋巴结放疗前CR、PR、NR组ADC值逐渐升高,而ΔADC值逐渐降低,放疗后治疗效果CR组最优,PR组优于NR组(P<0.05);高信号完全消失组,原发灶放疗前后ADC值均低于高信号部分消失组,而ΔADC值较高;转移淋巴结高信号完全消失组放疗前后ADC值、ΔADC均高于高信号部分消失组,差异具有统计学意义(P<0.05)。本文还进行了Cox回归模型多因素预后分析,发现TNM分期及DWMRI为影响预后的主要因素。本研究证实DWMRI对肿瘤治疗的微环境变化较为敏感,ADC值的变化可以在早期监视肿瘤诊断效果,为临床NSCLC治疗与诊断提供参考依据。

关键词: DWMRI, 周围型非小细胞癌(NSCLC), 诊断, 放化疗疗效

Abstract: This paper evaluated the diagnostic value of diffusion-weighted imaging (diffusion-weighted magnetic resonance imaging, DWMRI) in peripheral non-small cell carcinoma (NSCLC) and evaluate the efficacy of radiotherapy and chemotherapy. From January 2016 to January 2019, 100 cases of NSCLC were treated in our hospital. The prescription dose of radiotherapy was 46~66 Gy, 2.0~2.2 Gy once a day, 5 times a week, combined with chemotherapy. CT and DWMRI, were used before and after radiotherapy and chemotherapy to observe the short-term curative effect, the high signal expression of DWMRI, the change of apparent diffusion coefficient (apparent diffusion coefficient,ADC) value and the prognostic factors. CT and MRI images were used to evaluate the curative effect of 100 patients with NSCLC before and after radiotherapy. There were 28 cases in CR group, 53 cases in PR group, 19 cases in NR group (PD 2 cases, SD 17 cases). The effective rate was 81.00% in CR group and PR group. The 3-year progression-free survival rates were 89.29%, 46.42%, 39.28% and 56.60%, 37.74%, 33.97%, respectively (χ2=24.500,P=0.000). After radiotherapy, DWMRI hyperintensity disappeared in 35 cases and did not disappear in 65 cases, lymph node hyperintensity disappeared in 40 cases and not completely disappeared in 35 cases, primary focus of lung cancer in 18 cases, lymph node completely disappeared in 29 cases. The 1,2,3-year progression-free survival rates of NSCLC patients were 71.25%, 34.52%, 25.00% and 35.64%、4.50%、4.50%, respectively. (χ2=25.790,P=0.000). The CR, PR, NR group's ADC value of primary focus and metastatic lymph node increased gradually before radiotherapy, but Δ ADC value decreased gradually. After radiotherapy, the therapeutic effect of CR group was the best, PR group was better than NR group (P<0.05). In the group of complete disappearance of high signal, the ADC value of the primary focus before and after radiotherapy was lower than that of the group of partial disappearance of high signal, but the value of Δ ADC was higher than the group of partial disappearance of high signal. ADC and Δ ADC were significantly higher in patients with complete disappearance of metastatic lymph nodes before and after radiotherapy than those in patients with partial disappearance of hyperintense lymph nodes (P<0.05). Multivariate analysis of prognostic factors by Cox regression model. It was found that TNM stage and DWMRI were the main prognostic factors. This research shows that DWMRI is sensitive to the changes of microenvironment in the treatment of tumors, and the change of ADC is worthy of monitoring the effect of tumor diagnosis in the early stage, which can provide a better evaluation for the treatment and diagnosis of clinical NSCLC.

Key words: DWMRI, peripheral non-small cell carcinoma (NSCLC), diagnosis, efficacy of radiotherapy and chemotherapy