CAJ | 학술논문

目的：探讨磁共振弥散加权成像（DWI）对食管癌同步放化疗疗效预测和价值的评估。方法46例食管癌患者均在同步放化疗前，放化疗结束后1～3个月接受3．0T 磁共振 DWI 检查，根据食管病变及转移淋巴结高信号是否完全消失分为A 组（高信号完全消失），B 组（高信号始终未完全消失）。测量患者同步放化疗前后食管病变长度变化、正常组织与病变组织的表观弥散系数（ADC）值变化。根据磁共振 DWI 区分食管病变是否侵犯周围组织或器官，以及病变长度分为 T1-3组（未受侵袭）及 T4两组（受侵袭），分析两组病变 ADC 值之间的差异；在磁共振 DWI 图像对纵隔淋巴结进行判定，并根据其有无转移分为 N0组（无转移）和 N1组（有转移），对两组食管病变ADC 值之间的差异进行分析。结果同步放化疗后食管病变长度明显短于同步放化疗前，经比较差异有统计学意义。A、B 组放化疗前、后 ADC 值均明显低于食管正常组织。各组放化疗后 ADC 值均较放化疗前明显增加。A 组放化疗后 ADC 值明显高于 B 组。T1-3组、T4组患者 ADC 值差异无统计学意义。N0组 ADC 值明显高于 N1组，经比较差异有统计学意义。结论同步放化疗可使食管病变明显变小；放化疗后食管恶性病变组织ADC 值明显升高，提示 ADC 值可与形态学改变之前较早，较准确地反映肿瘤内部代谢变化及对同步放化疗的反应。
목적：탐토자공진미산가권성상（DWI）대식관암동보방화료료효예측화개치적평고。방법46례식관암환자균재동보방화료전，방화료결속후1～3개월접수3．0T 자공진 DWI 검사，근거식관병변급전이림파결고신호시부완전소실분위A 조（고신호완전소실），B 조（고신호시종미완전소실）。측량환자동보방화료전후식관병변장도변화、정상조직여병변조직적표관미산계수（ADC）치변화。근거자공진 DWI 구분식관병변시부침범주위조직혹기관，이급병변장도분위 T1-3조（미수침습）급 T4량조（수침습），분석량조병변 ADC 치지간적차이；재자공진 DWI 도상대종격림파결진행판정，병근거기유무전이분위 N0조（무전이）화 N1조（유전이），대량조식관병변ADC 치지간적차이진행분석。결과동보방화료후식관병변장도명현단우동보방화료전，경비교차이유통계학의의。A、B 조방화료전、후 ADC 치균명현저우식관정상조직。각조방화료후 ADC 치균교방화료전명현증가。A 조방화료후 ADC 치명현고우 B 조。T1-3조、T4조환자 ADC 치차이무통계학의의。N0조 ADC 치명현고우 N1조，경비교차이유통계학의의。결론동보방화료가사식관병변명현변소；방화료후식관악성병변조직ADC 치명현승고，제시 ADC 치가여형태학개변지전교조，교준학지반영종류내부대사변화급대동보방화료적반응。
Objective To explore the value of 3.0T diffusion weighted imaging (DWI)in predicating and evaluating the efficacy of concurrent chemoraidotherapy (CCRT)in esophageal car-cinoma.Methods A total of 46 patients with esophageal carcinoma were divided into group A (with complete disappearance of high signal intensity)and group B (with incomplete disappearance of high signal intensity)based on the complete disappearance of high signal intensity of esophageal lesion and metastatic lymph node after 1 to 3 months of CCRT so as to measure the changes of esophageal lesion length and apparent diffusion coefficient (ADC)value of normal and lesion tissues, and were divided into T1-3 group (without affection)and T4 group (with affection)to analyze the differentiation of ADC values in both groups,according to the affection of esophageal lesion to sur-rounding tissues and organs distinguished by DWI.Additionally,all patients were divided into N0 group (without metastasis)and N1 group (with metastasis)on the basis of metastasis of medi-astinum lymph node determined by DWI,so as to analyze the differentiation of ADC values in both groups.Results After CCRT,esophageal lesion length decreased evidently than treatment before and the difference was statistically significant.ADC values in groups A and B were obviously lower than that in the esophageal normal tissues before and after treatment,while ADC value increased markedly in all groups after treatment compared with the treatment before,and ADC value was ap-parently higher in group A than that in group B.However,there was no significant difference be-tween T1-3 and T4 groups.Moreover,N0 group was obviously higher than N1 group in ADC value,and the difference was significant.Conclusion CCRT can obviously shorten esophageal lesion and increase ADC value in malignant lesion tissues of tumor,which suggested that ADC value can re-flect the internal metabolism changes and concurrent chemoraidotherapy of tumor earlier and more accurately.