CAJ | 학술논문

目的探讨不同b值联合评估宫颈癌化放疗早期疗效的价值.方法 30例接受全程化放疗治疗的宫颈癌患者分别于治疗前、治疗2周后及治疗结束时行盆腔常规MRI成像及弥散加权成像(DWI)扫描,并根据治疗结束9个月随访将患者分为完全缓解(CR)组(15例)、部分有效(PR)组(9例)、稳定(SD)组(6例),分别计算及两两比较各次扫描的表观弥散系数(ADC)及直径变化,在b=0、600 s/mm2和b=0、1000 s/mm2 ADC图上分别计算ADC,根据受试者工作特征(ROC)曲线比较不同b值ADC图评估宫颈癌化放疗疗效及预后的价值.结果三组治疗前、治疗2周后ADC在b=0、600 s/mm2 ADC图和b=0、1000 s/mm2 ADC图比较差异均无统计学意义(P＞0.05).CR组治疗2周后ADC提高比均高于PR组和SD组(0.35±0.10比0.22±0.10、0.21±0.08和0.28±0.08比0.14±0.04、0.16±0.02),差异有统计学意义(P＜0.05)；PR组与SD组比较差异无统计学意义(P＞ 0.05).治疗2周后CR、PR及SD组肿瘤直径降低比分别为0.36±0.18、0.33±0.17和0.24±0.09,两两比较差异无统计学意义(F=1.151,P＞ 0.05).治疗2周后在b=0、600s/mm2ADC图上,当ADC阈值设为0.211×10-3 mm2/s时,ROC曲线下面积为0.976,灵敏度为85.6％,特异度为100.0％；在b=0、1000s/mm2ADC图上,当ADC阈值设为0.181×10-3 mm2/s时,ROC曲线下面积为0.979,灵敏度为85.6％,特异度为100.0％；两种ADC图评估宫颈癌化放疗早期疗效的准确度均较高,且大致相当.结论治疗2周后ADC提高比可以用于预测宫颈癌患者化放疗的疗效；两种b值的评估疗效价值相当.
목적 탐토불동b치연합평고궁경암화방료조기료효적개치.방법 30례접수전정화방료치료적궁경암환자분별우치료전、치료2주후급치료결속시행분강상규MRI성상급미산가권성상(DWI)소묘,병근거치료결속9개월수방장환자분위완전완해(CR)조(15례)、부분유효(PR)조(9례)、은정(SD)조(6례),분별계산급량량비교각차소묘적표관미산계수(ADC)급직경변화,재b=0、600 s/mm2화b=0、1000 s/mm2 ADC도상분별계산ADC,근거수시자공작특정(ROC)곡선비교불동b치ADC도평고궁경암화방료료효급예후적개치.결과 삼조치료전、치료2주후ADC재b=0、600 s/mm2 ADC도화b=0、1000 s/mm2 ADC도비교차이균무통계학의의(P＞0.05).CR조치료2주후ADC제고비균고우PR조화SD조(0.35±0.10비0.22±0.10、0.21±0.08화0.28±0.08비0.14±0.04、0.16±0.02),차이유통계학의의(P＜0.05)；PR조여SD조비교차이무통계학의의(P＞ 0.05).치료2주후CR、PR급SD조종류직경강저비분별위0.36±0.18、0.33±0.17화0.24±0.09,량량비교차이무통계학의의(F=1.151,P＞ 0.05).치료2주후재b=0、600s/mm2ADC도상,당ADC역치설위0.211×10-3 mm2/s시,ROC곡선하면적위0.976,령민도위85.6％,특이도위100.0％；재b=0、1000s/mm2ADC도상,당ADC역치설위0.181×10-3 mm2/s시,ROC곡선하면적위0.979,령민도위85.6％,특이도위100.0％；량충ADC도평고궁경암화방료조기료효적준학도균교고,차대치상당.결론 치료2주후ADC제고비가이용우예측궁경암환자화방료적료효；량충b치적평고료효개치상당.
Objective To observe the evaluation of early chemoradiotherapy efficacy in uterine cervical cancer by different b-value combination.Methods Thirty uterine cervical cancer patients who were treated with chemoradiotherapy received conventional MRI and diffusion weighted imaging (DWI) before treatment,after 2 weeks treatment and after treatment.The patients were divided into complete remission (CR) group (15 cases),partial remission (PR) group (9 cases),stable disease (SD) group (6 cases) according to the changes in tumor size after 9 months of treatment.The tumor size and apparent diffusion coefficient (ADC) of uterine cervical cancer were measured at each examination among the 3 groups.All ADC were calculated with b =0,600 s/mm2 and b =0,1000 s/mm2.According the receiver operating characteristic (ROC) curve,chemoradiotherapy efficacy and prognosis value of different b-value of ADC chart in uterine cervical cancer were compared.Results There were no significant differences in ADC of b =0,600 s/mm2 ADC chart and b =0,1000 s/mm2 ADC chart before treatment and after 2 weeks treatment in the 3 groups (P＞ 0.05).ADC increase rate after 2 weeks treatment in CR group was significantly higher than that in PR group and SD group (0.35 ± 0.10 vs.0.22 ± 0.10 and 0.21 ± 0.08,0.28 ± 0.08 vs.0.14 ±0.04 and 0.16 ± 0.02,P ＜ 0.05).There was no significant difference between PR group and SD group (P ＞0.05).The decrease rates of tumor diameter after 2 weeks treatment in CR,PR and SD group were 0.36 ±0.18,0.33 ± 0.17 and 0.24 ± 0.09,there were no significant differences (F=1.151,P ＞ 0.05).After 2 weeks treatment,at b =0,600 s/mm2 ADC chart,when liminal value of ADC was 0.211 × 10-3 mm2/s,ROC area under curve was 0.976,sensitivity was 85.6％,specificity was 100.0％; at b =0,1000 s/mm2 ADC chart,when liminal value of ADC was 0.181 × 10-3 mm2/s,ROC area under curve was 0.979,sensitivity was 85.6％,specificity was 100.0％.The accuracy of two kinds of ADC chart evaluation of uterine cervical cancer early chemoradiotherapy efficacy was higher,and the effect was similar.Conclusion The ADC increase rate after 2 weeks treatment can be used to predict the early chemoradiotherapy efficacy of uterine cervical cancer,and the value of two kinds of ADC chart of different b-value is similar.