中华放射学杂志
中華放射學雜誌
중화방사학잡지
Chinese Journal of Radiology
2014年
6期
467-471
,共5页
林蒙%余小多%罗德红%欧阳汉%周纯武
林矇%餘小多%囉德紅%歐暘漢%週純武
림몽%여소다%라덕홍%구양한%주순무
鼻咽肿瘤%磁共振成像%治疗效果
鼻嚥腫瘤%磁共振成像%治療效果
비인종류%자공진성상%치료효과
Nasopharyngeal neoplasms%Magnetic resonance imaging%Treatment outcome
目的：探讨MR DWI预测鼻咽癌患者对同步放化疗治疗敏感性的价值。方法收集经鼻咽镜活检病理证实且随后行同步放化疗的鼻咽癌初治患者70例。所有患者均于治疗前及放疗剂量达50 Gy时行DWI检查。测量治疗前肿瘤不同区域ADC值（包括平均ADC值、最高ADC值及最低ADC值），计算放疗剂量达50 Gy时的肿瘤消退率（RS0-50），并参考实体瘤疗效评价标准分为治疗敏感组、疗效中间组和治疗抗拒组。根据患者的病理类型和临床分期分别进行分组。对全部肿瘤、不同病理类型及分期肿瘤的RS0-50与治疗前不同区域ADC值分别进行Spearman等级相关分析，对与肿瘤RS0-50相关性最高的ADC值进行ROC分析，并提出其预测治疗敏感度最佳阈值及诊断效能。结果3例患者因DWI有明显吞咽伪影，影响数据测量而不进行分析，最终分析67例患者资料。其中非角化分化型癌49例，非角化未分化型癌18例。肿瘤T1期7例，T2期14例，T3期17例，T4期29例。放疗50 Gy时治疗敏感组、疗效中间组和治疗抗拒组患者分别为13、42和12例。治疗前肿瘤平均ADC值为（1.06±0.19）×10-3 mm2/s，最高 ADC 值为（1.29±0.33）×10-3 mm2/s，分别与RS0-50[（65.6±3.1）％]呈低度及中度负相关（r值分别为-0.276和-0.434，P值均＜0.05）。最低ADC值为（0.78±0.16）×10-3 mm2/s，和 RS0-50无相关性（ r ＝0.051， P ＝0.680）。以肿瘤最高ADC值＜1.06×10-3 mm2/s 为阈值，预测治疗敏感者的敏感度、特异度及准确度分别为69.2％（9/13）、88.9％（48/54）及85.1％（57/67），ROC曲线下面积为0.816。以肿瘤最高ADC值≥1.30×10-3 mm2/s为阈值，预测治疗抗拒者的敏感度、特异度及准确度分别为75.0％（9/12）、65.5％（36/55）及67.2％（45/67），曲线下面积为0.707。结论鼻咽癌治疗前原发肿瘤最高ADC值能够较好地预测鼻咽癌治疗后消退情况与治疗敏感性。
目的：探討MR DWI預測鼻嚥癌患者對同步放化療治療敏感性的價值。方法收集經鼻嚥鏡活檢病理證實且隨後行同步放化療的鼻嚥癌初治患者70例。所有患者均于治療前及放療劑量達50 Gy時行DWI檢查。測量治療前腫瘤不同區域ADC值（包括平均ADC值、最高ADC值及最低ADC值），計算放療劑量達50 Gy時的腫瘤消退率（RS0-50），併參攷實體瘤療效評價標準分為治療敏感組、療效中間組和治療抗拒組。根據患者的病理類型和臨床分期分彆進行分組。對全部腫瘤、不同病理類型及分期腫瘤的RS0-50與治療前不同區域ADC值分彆進行Spearman等級相關分析，對與腫瘤RS0-50相關性最高的ADC值進行ROC分析，併提齣其預測治療敏感度最佳閾值及診斷效能。結果3例患者因DWI有明顯吞嚥偽影，影響數據測量而不進行分析，最終分析67例患者資料。其中非角化分化型癌49例，非角化未分化型癌18例。腫瘤T1期7例，T2期14例，T3期17例，T4期29例。放療50 Gy時治療敏感組、療效中間組和治療抗拒組患者分彆為13、42和12例。治療前腫瘤平均ADC值為（1.06±0.19）×10-3 mm2/s，最高 ADC 值為（1.29±0.33）×10-3 mm2/s，分彆與RS0-50[（65.6±3.1）％]呈低度及中度負相關（r值分彆為-0.276和-0.434，P值均＜0.05）。最低ADC值為（0.78±0.16）×10-3 mm2/s，和 RS0-50無相關性（ r ＝0.051， P ＝0.680）。以腫瘤最高ADC值＜1.06×10-3 mm2/s 為閾值，預測治療敏感者的敏感度、特異度及準確度分彆為69.2％（9/13）、88.9％（48/54）及85.1％（57/67），ROC麯線下麵積為0.816。以腫瘤最高ADC值≥1.30×10-3 mm2/s為閾值，預測治療抗拒者的敏感度、特異度及準確度分彆為75.0％（9/12）、65.5％（36/55）及67.2％（45/67），麯線下麵積為0.707。結論鼻嚥癌治療前原髮腫瘤最高ADC值能夠較好地預測鼻嚥癌治療後消退情況與治療敏感性。
목적：탐토MR DWI예측비인암환자대동보방화료치료민감성적개치。방법수집경비인경활검병리증실차수후행동보방화료적비인암초치환자70례。소유환자균우치료전급방료제량체50 Gy시행DWI검사。측량치료전종류불동구역ADC치（포괄평균ADC치、최고ADC치급최저ADC치），계산방료제량체50 Gy시적종류소퇴솔（RS0-50），병삼고실체류료효평개표준분위치료민감조、료효중간조화치료항거조。근거환자적병리류형화림상분기분별진행분조。대전부종류、불동병리류형급분기종류적RS0-50여치료전불동구역ADC치분별진행Spearman등급상관분석，대여종류RS0-50상관성최고적ADC치진행ROC분석，병제출기예측치료민감도최가역치급진단효능。결과3례환자인DWI유명현탄인위영，영향수거측량이불진행분석，최종분석67례환자자료。기중비각화분화형암49례，비각화미분화형암18례。종류T1기7례，T2기14례，T3기17례，T4기29례。방료50 Gy시치료민감조、료효중간조화치료항거조환자분별위13、42화12례。치료전종류평균ADC치위（1.06±0.19）×10-3 mm2/s，최고 ADC 치위（1.29±0.33）×10-3 mm2/s，분별여RS0-50[（65.6±3.1）％]정저도급중도부상관（r치분별위-0.276화-0.434，P치균＜0.05）。최저ADC치위（0.78±0.16）×10-3 mm2/s，화 RS0-50무상관성（ r ＝0.051， P ＝0.680）。이종류최고ADC치＜1.06×10-3 mm2/s 위역치，예측치료민감자적민감도、특이도급준학도분별위69.2％（9/13）、88.9％（48/54）급85.1％（57/67），ROC곡선하면적위0.816。이종류최고ADC치≥1.30×10-3 mm2/s위역치，예측치료항거자적민감도、특이도급준학도분별위75.0％（9/12）、65.5％（36/55）급67.2％（45/67），곡선하면적위0.707。결론비인암치료전원발종류최고ADC치능구교호지예측비인암치료후소퇴정황여치료민감성。
Objective To investigate the value of DWI before treatment on predicting sensitivity of concurrent chemoradiation in nasopharyngeal carcinoma.Methods Seventy patients with nasopharyngeal carcinoma proved by nasopharyngoscope and biopsy pathology conducted DWI before concurrent chemoradiation and reexamined on receiving dose of 50 Gy.The mean, maximum and minimum ADC value of tumor were measured on DWI and maximum area of tumor before and during treatment ( on dose of 50 Gy) was delineated to calculate the tumor regression rate ( RS0-50 ).The patients were classified into three groups according to the RS0-50 as sensitive, moderate, and resistant therapeutic effect.Patients were classified into different groups according to the pathologic type and clinical stage respectively .Spearman correlation analysis was used between RS 0-50 and ADC values of all tumors , different pathologic types and clinical stages , respectively.ROC was used to evaluate the cutoff and value of ADC which had highest correlation to RS0-50 on predicting therapeutic effect.Results DWI of 3 patients were excluded due to obvious swallow artifact which influenced the measurement , and finally 67 patients were included in this study, with pathological type of nonkeratinized differentiated undifferentiated carcinoma in 49 cases, nonkeratinized undifferentiated carcinoma in 18 cases, clinical T1 stage in 7 cases, T2 in 14 cases, T3 in 17 cases and T4 in 29 cases.During treatment , there were 13 cases with sensitive therapeutic effect , 42 cases with moderate therapeutic effect and 12 cases with resistant therapeutic effect.RS0-50 [ ( 65.6 ± 3.1) %] showed mildly and moderately negative correlation to mean ADC [(1.06 ±0.19) ×10 -3 mm2/s] and maximum ADC [(1.29 ±0.33) ×10 -3 mm2/s] respectively ( r =-0.276, P =0.024 and r =-0.434, P=0.001, respectively).ROC showed when setting threshold at maximum ADC value of lower than 1.06 ×10 -3 mm2/s for predicting sensitive therapeutic effect , the specificity , sensitivity , and accuracy was 69.2%(9/13), 88.9%(48/54) and 85.1% (57/67), respectively, and when setting threshold at maximum ADC value of higher than and equal to 1.30 ×10 -3 mm2/s for predicting resistant therapeutic effect, the specificity, sensitivity, and accuracy was 75.0% (9/12), 65.5% (36/55) and 67.2%(45/67), respectively.Conclusion Pretreatment maximum ADC value were able to predict the tumor regression rate and sensitivity of concurrent chemoradiation in nasopharyngeal carcinoma .
