3.0T MRDWI預(yù)測鼻咽癌放化療敏感性的研究

于紅梅翟昭華顧　明馬代遠劉　念

論著

3.0T MRDWI預(yù)測鼻咽癌放化療敏感性的研究

于紅梅1翟昭華2顧明1馬代遠3劉念2

目的探討 3.0 T MR擴散加權(quán)成像（DWI）在評估鼻咽癌（NPC）放化療（CRT）療效中的價值，預(yù)測NPC對CRT的敏感性。方法收集32例經(jīng)病理證實的NPC病人，行常規(guī)MRI及DWI檢查，測量CRT前與CRT 5周時NPC及轉(zhuǎn)移性淋巴結(jié)最大者的體積和ADC值。以CRT后1個月病理活檢和MRI檢查作為療效評價標準將NPC分為低敏感與高敏感組，比較CRT 5周時NPC低敏感組與高敏感組ADC值、治療前后ADC值變化率（ΔADC）及體積消退率（ΔV）的差異；分析影響NPC CRT敏感性的相關(guān)因素。結(jié)果CRT 5周時NPC ADC值、ΔADC及ΔV在高、低敏感組之間差異均有統(tǒng)計學意義（P＜0.05），ΔADC為鑒別低敏感與高敏感組最佳指標，其截斷值為98.125%，敏感度為95.5%，特異度為90%。非線性Logistic回歸分析影響NPC CRT敏感性的相關(guān)因素（性別、年齡、治療方式、T分期及ΔADC），結(jié)果顯示ΔADC是影響NPC CRT敏感程度的獨立預(yù)后因素，其相對風險度為1.155。結(jié)論DWI對于評價NPC CRT療效有重要作用。CRT 5周時NPC ADC值、ΔADC及ΔV都能有效預(yù)測NPC CRT敏感性，ΔADC是預(yù)測NPC CRT敏感性的最佳指標及獨立預(yù)后因素。

鼻咽癌；擴散加權(quán)成像；表觀擴散系數(shù)；放化療；敏感性

【Abstract】ObjebtiveTo investigate the value of diffusion-weighted 3.0 T MR imaging（DW-MRI）for evaluating therapeutic effect of chemoradiotherapy（CRT）and predicting sensitivity of CRT in nasopharyngeal carcinoma（NPC）.

MethodsThirty-two cases with NPC confirmed by pathological biopsy underwent conventional MRI and DWI.We measured the apparent diffusion coefficient（ADC）values before and 5 weeks after CRT.At the same time，the volume of NPC primary tumors and metastatic lymph nodes were measured.Thirty-two cases were grouped into hypersensitivity and hyposensitivity groups based on pathologicaly and MRI findings after a month of therapy.The ADC values，change rate of ADC values（ΔADC），and volume of faded rate（ΔV）during the 5 weeks were compared between the hypersensitivity and hyposensitivity groups.Logistic regression analysis was used to determine sensitive factors for in NPC chemoradiotherapy.

ResultsThe ADC，ΔADC and ΔV value of NPC were statistically difference between hypersensitivity and hyposensitivity groups（P＜0.05）at 5 weeks afer CRT.The ΔADC was the best measure to discriminate the two groups（cutoff 98.125%，sensitivity，95.5%，specificity，90%）.Nonlinear Logistic regression analysis including sex，age，treatment，T stage，and ΔADC showed that ΔADC was dependent variable for effecting CRT sensitivity of NPC（relative risk，1.155）.ConclusionDWI has an important role in evaluating therapeutic effect of CRT in NPC.The ADC value，ΔADC，and ΔV of NPC at 5 weeks after CRT could predict the CRT sensitivity.The ΔADC is the best indicator in predicting CRT sensitivity，and is a dependent variable for effecting CRT sensitivity in NPC.

鼻咽位于頭頸聯(lián)合區(qū)深部，解剖結(jié)構(gòu)復(fù)雜，鄰近重要器官和顱內(nèi)神經(jīng)，鼻咽部腫瘤外科手術(shù)風險較高。目前，以放療為主的綜合治療是鼻咽癌（nasopharyngeal carcinoma，NPC）的主要治療方法，采用MR

1　材料與方法

1.1一般資料隨機抽取成都軍區(qū)總醫(yī)院于2013 年3月—2014年2月期間經(jīng)病理活檢證實的NPC病人32例，男26例，女6例，年齡26～64歲，平均（45.4±8.3）歲。病理類型均為低分化鱗癌，有淋巴結(jié)轉(zhuǎn)移者經(jīng)病理活檢證實。其中，T1期8例，T2期15例，T3期3例，T4期6例?！?br>