CAJ | 학술논문

目的探讨ADC值对直肠癌术前放化疗疗效的早期监测的可行性及应用价值.方法搜集2004年12月到2006年10月26例经病理证实的原发性直肠癌患者,术前行常规MRI和DWI检查.测量放化疗过程中不同监测时间点(包括治疗前、治疗后第1周、治疗后第2周、手术前)肿瘤ADC值.以放化疗前肿瘤的临床T分期与术后病理T分期比较,以T分期是否降低为标准,分为治疗效果较好的T-降期组和治疗效果较差的T-未降期组.应用随机区组设计的方差分析比较肿瘤ADC值变化情况.结果 26例中,T-降期组和T-未降期组分别为12和14例.T-降期组治疗前、治疗后第1周、治疗后第2周、手术前ADC值分别为(1.10±0.13)×10~(-3)、(1.32±0.19)×10~(-3)、(1.35±0.13)×10~(-3)和(1.32±1.00)×10~(-3) mm~2/s,差异有统计学意义(F=16.420,P＜0.01).T-未降期组在治疗后第1周ADC值由(1.16±0.16)×10~(-3) mm~2/g升高至(1.23±0.13)×10-3 mm~2/s,升高不明显(P＞0.05),在治疗后第2周ADC值继续升高至(1.30±0.16)×10-3 mm~2/s,差异有统计学意义(F=5.023,P＜0.01).用治疗后第1周肿瘤平均ADC值升高程度11.6%作为诊断直肠癌T分期是否出现降期的指标,诊断敏感性为75.O%,特异性为78.6%,阳性预测值为75.0%,阴性预测值为78.6%.ROC曲线下面积为0.774(95%可信区间为0.583～0.964),具有中等诊断价值.结论 ADC值具有作为早期监测直肠癌放化疗疗效影像学指标的可能性.治疗第1周肿瘤平均ADC值变化对于区分放化疗反应性较为敏感,可以作为有效的时间监测点.
목적 탐토ADC치대직장암술전방화료료효적조기감측적가행성급응용개치.방법 수집2004년12월도2006년10월26례경병리증실적원발성직장암환자,술전행상규MRI화DWI검사.측량방화료과정중불동감측시간점(포괄치료전、치료후제1주、치료후제2주、수술전)종류ADC치.이방화료전종류적림상T분기여술후병리T분기비교,이T분기시부강저위표준,분위치료효과교호적T-강기조화치료효과교차적T-미강기조.응용수궤구조설계적방차분석비교종류ADC치변화정황.결과 26례중,T-강기조화T-미강기조분별위12화14례.T-강기조치료전、치료후제1주、치료후제2주、수술전ADC치분별위(1.10±0.13)×10~(-3)、(1.32±0.19)×10~(-3)、(1.35±0.13)×10~(-3)화(1.32±1.00)×10~(-3) mm~2/s,차이유통계학의의(F=16.420,P＜0.01).T-미강기조재치료후제1주ADC치유(1.16±0.16)×10~(-3) mm~2/g승고지(1.23±0.13)×10-3 mm~2/s,승고불명현(P＞0.05),재치료후제2주ADC치계속승고지(1.30±0.16)×10-3 mm~2/s,차이유통계학의의(F=5.023,P＜0.01).용치료후제1주종류평균ADC치승고정도11.6%작위진단직장암T분기시부출현강기적지표,진단민감성위75.O%,특이성위78.6%,양성예측치위75.0%,음성예측치위78.6%.ROC곡선하면적위0.774(95%가신구간위0.583～0.964),구유중등진단개치.결론 ADC치구유작위조기감측직장암방화료료효영상학지표적가능성.치료제1주종류평균ADC치변화대우구분방화료반응성교위민감,가이작위유효적시간감측점.
Objective To assess response of rectal carcinoma to preoperative chemoradiation therapy(CRT)using DWI and tumor ADC values,and to investigate the value of ADC in predicting and monitoring therapeutic effect of CRT.Methods Twenty-six patients with primary rectal carcinoma undergoing preoperative CRT were recruited to the study.DWI was performed on a 1.5 T MR scanner in all patients at the time point of pre-therapy,the end of the 1st,2nd week of therapy and pre-operation,respectively.ADC values of the tumors were calculated on the workstation.Randomized block design was applied to analyze change in ADCs following treatment Results All patients were divided into T-downstaging group(n=12)and T-non-downstaging group(n=14).In T-downstaging group,the mean tumor ADC values were(1.10±0.13)×10~(-3),(1.32±0.19)×10~(-3),(1.35±0.13)×10~(-3),(1.32±1.00)×10~(-3) mm~2/s at the time point of pretreatment,week 1,week 2,pre-operation,respectively(F=16.420,P＜0.01).The mean tumor ADC value in T-non-downstaging had a slight increase from(1.16±0.16)×10~(-3) mm~2/s to(1.23±0.13)×10~(-3) mm~2/s at the time of week 1(P＞0.05).The ADC value in T-non-downstaging group continuously increased to(1.30±0.16)×10~(-3) mm~2/s at the end of the 2nd week of CRT(F=5.023,P＜0.01)and appeared statistical difference.The evolution of tumor ADC values in the two groups was significantly different.Early increases in tumor ADC were observed in T-downstaging group.Regarding the increase percentage of ADC value at 1st week as a diagnostic marker of tumor downstaging,when it was set as 11.6%,the sensitivity,specificity,positive predictive value and negative predictive value is 75.0%,78.6%,75.0% and 78.6% respectively,the area under curve(Az)was 0.774(95% confidence interval:0.583 to 0.964).Conclusions An early significant increase of mean tumor ADC value in rectal carcinoma has a potential to predict therapeutic effect of CRT.One week after beginning CRT is an early time point to monitor therapy efficacy.