CAJ | 학술논문

目的探讨MR DWI对骨肉瘤新辅助化疗效果评估的价值.方法 36例原发性骨肉瘤患者新辅助化疗(顺铂+甲氨喋呤+表阿霉素+异环磷酰胺)前、后进行常规MBI、DWI.检查采用1.5 T超导型MR仪,测定化疗前、后肿瘤内活性肿瘤组织、坏死区及肿瘤平均ADC值变化.术后病理肿瘤坏死率评估按Huvos标准分级.用两独立样本t检验法检验化疗反应不同2组病例的各项指标.结果 36例化疗后肿瘤内活性肿瘤组织和坏死区的ADC值分别为(1.06±0.30)×10-3mm2/s和(2.39±0.44)×10-3mm2/s,坏死区ADC值明显高于活性肿瘤组织,两者间差异有统计学意义(t=3.515,P<0.05).25例化疗反应良好组肿瘤平均ADC值由化疗前的(1.18±0.19)×10-3mm2/s增加至化疗后(2.27±0.20)×10-3mm/s,11例化疗反应不佳组的平均ADC值从化疗前(1.45±0.11)×10-3mm2/s增加至化疗后(1.83±0.16)×10-3mm/s,两组间化疗前后ADC值变化差异有统计学意义(t=4.981,P<0.01).结论 DWI能够区分新辅助化疗后骨肉瘤内活性肿瘤组织与坏死组织,进而对骨肉瘤化疗效果的评估有一定价值,结合常规MR检查,对手术计划的制定、术后化疗方案的选择及判断患者预后有重要帮助.
목적 탐토MR DWI대골육류신보조화료효과평고적개치.방법 36례원발성골육류환자신보조화료(순박+갑안첩령+표아매소+이배린선알)전、후진행상규MBI、DWI.검사채용1.5 T초도형MR의,측정화료전、후종류내활성종류조직、배사구급종류평균ADC치변화.술후병리종류배사솔평고안Huvos표준분급.용량독립양본t검험법검험화료반응불동2조병례적각항지표.결과 36례화료후종류내활성종류조직화배사구적ADC치분별위(1.06±0.30)×10-3mm2/s화(2.39±0.44)×10-3mm2/s,배사구ADC치명현고우활성종류조직,량자간차이유통계학의의(t=3.515,P<0.05).25례화료반응량호조종류평균ADC치유화료전적(1.18±0.19)×10-3mm2/s증가지화료후(2.27±0.20)×10-3mm/s,11례화료반응불가조적평균ADC치종화료전(1.45±0.11)×10-3mm2/s증가지화료후(1.83±0.16)×10-3mm/s,량조간화료전후ADC치변화차이유통계학의의(t=4.981,P<0.01).결론 DWI능구구분신보조화료후골육류내활성종류조직여배사조직,진이대골육류화료효과적평고유일정개치,결합상규MR검사,대수술계화적제정、술후화료방안적선택급판단환자예후유중요방조.
Objective To determine the utility of diffusion-weighted magnetic resonance imaging ( MR DWI ) in detecting tumor necrosis with histological correlation after neoacljuvant chemotherapy. Methods Conventional MRI and DWI were obtained from 36 patients with histological proven esteosarcoma. Magnetic resonance examinations were performed in all patients before and after 4 cycles of preoperative neoadjuvant chemotherapy. Apparent diffusion coefficients (ADC) were calculated. The degree of tumor necrosis was assessed using the histological Huvos classification after chemotherapy. T-test was performed for testing changes in ADC value between the 2 groups. P value less than 0. 05 were considered as a statistically significant difference. Results The differences in ADC between viable [ (1.06±0. 30) ×10-3mm2/s ] and necrotic [ (2. 39±0. 44 )×10-3mm2/s] tumor were significant (t= 3. 515,P<0. 05). Changes in ADC value was greater in good responses to neoadjuvant chemotherapy than in poor responses, the ADC value in good responses was increased from (1.18±0. 19)×10-3mm2/s to (2. 27±0. 20)×10-3mm2/s, the corresponding value in poor responses was increased from (1.45± 0.11)×10-3mm2/s to (1.83±0. 16)×10-3mm2/s, There was significant difference in changes of ADC values between good responses and poor responses ( t = 4. 981, P < 0. 01 ). Conclusion Diffusion-weighted MRI permits recognition of tumor necrosis induced by chemotherapy in osteosarcoma. DWI is correlated directly with tumor necrosis. They have potential utility in evaluating the preoperative chemotherapy response in patients with primary osteosarcoma.