CAJ | 학술논문

目的探讨宫颈癌MR血氧水平依赖性成像(BOLD)的可行性及治疗前后肿瘤乏氧功能参数变化情况,初步研究其预测疗效的价值.方法收集28例临床诊断的进展期宫颈癌患者进行氧刺激(95％O2 +5％CO2高氧浓度混合气体)BOLD成像,其中14例完成根治性同期放化疗者还进行治疗后复查,获取肿瘤乏氧功能参数值,包括基线(空气)R2*值及动态(氧刺激前后R2*差值)△R2*值.采用独立样本t检验比较治疗前宫颈肿瘤组织与宫体肌层的基线R2*值,配对t检验比较治疗前肿瘤组织氧刺激前后的R2*值变化,采用Wilcoxon符号秩和检验比较肿瘤治疗前后基线及动态R2*值的变化情况,治疗前基线及动态R2*值在临床不同疗效组间的差异比较采用非参数MannWhitney U检验.结果 MR BOLD乏氧成像快捷,图像清晰.治疗前宫颈肿瘤与宫体肌层基线R2*值分别为(15.92 ±2.71)/s和(22.76±3.79)/s,差异有统计学意义(t=6.474,P＜0.01).吸入高氧混合气体后肿瘤组织R2*值下降,吸入前和吸入后分别为(15.92±2.71)/s和(12.44 ±2.51)/s,差异有统计学意义(t=7.886,P＜0.01).治疗后肿瘤基线R2*值上升,治疗前后中位数分别为15.67/s和20.92/s；治疗后肿瘤动态(氧刺激)△R2*值较前下降,治疗前后中位数分别为2.23/s和1.01/s,差异均有统计学意义(Z值分别为-2.731和-2.103,P值均＜0.05).疗效好和差的患者分别为8和6例,治疗前基线R2*及动态(氧刺激)△R2*值差异均无统计学意义(P值均＞ 0.05).结论 MR BOLD成像临床可行,乏氧功能参数在治疗前后的变化间接反映了肿瘤内部氧合状态的改变情况.
목적 탐토궁경암MR혈양수평의뢰성성상(BOLD)적가행성급치료전후종류핍양공능삼수변화정황,초보연구기예측료효적개치.방법수집28례림상진단적진전기궁경암환자진행양자격(95％O2 +5％CO2고양농도혼합기체)BOLD성상,기중14례완성근치성동기방화료자환진행치료후복사,획취종류핍양공능삼수치,포괄기선(공기)R2*치급동태(양자격전후R2*차치)△R2*치.채용독립양본t검험비교치료전궁경종류조직여궁체기층적기선R2*치,배대t검험비교치료전종류조직양자격전후적R2*치변화,채용Wilcoxon부호질화검험비교종류치료전후기선급동태R2*치적변화정황,치료전기선급동태R2*치재림상불동료효조간적차이비교채용비삼수MannWhitney U검험.결과 MR BOLD핍양성상쾌첩,도상청석.치료전궁경종류여궁체기층기선R2*치분별위(15.92 ±2.71)/s화(22.76±3.79)/s,차이유통계학의의(t=6.474,P＜0.01).흡입고양혼합기체후종류조직R2*치하강,흡입전화흡입후분별위(15.92±2.71)/s화(12.44 ±2.51)/s,차이유통계학의의(t=7.886,P＜0.01).치료후종류기선R2*치상승,치료전후중위수분별위15.67/s화20.92/s；치료후종류동태(양자격)△R2*치교전하강,치료전후중위수분별위2.23/s화1.01/s,차이균유통계학의의(Z치분별위-2.731화-2.103,P치균＜0.05).료효호화차적환자분별위8화6례,치료전기선R2*급동태(양자격)△R2*치차이균무통계학의의(P치균＞ 0.05).결론 MR BOLD성상림상가행,핍양공능삼수재치료전후적변화간접반영료종류내부양합상태적개변정황.
Objective To investigate the application of MR BOLD imaging in uterine cervical cancer and the value of hypoxia related MR parameters R2 * and △R2 * in monitoring treatment response and predicting prognosis.Methods Twenty eight female patients with locally advanced uterine cervical cancer were studied prospectively.MR BOLD imaging was performed in 3.0 T MR scanner with the air and Carbogen gas mixture (95％ O2 + 5％ CO2) inhalation alternately,14 patients were accomplished with the same protocol before and after the treatment.The hypoxia related parameters:tumor baseline R2 * (air) and dynamic △R2 * (R2 * changed values before and after carbogen gas inhalation) were obtained.Independent t test was used to compare the baseline R2* values between cervical cancer tissue and uterine myometrium.Paired t test and Wilcoxon signed rank test were used to compare the hypoxia related parameters changes after carbogen gas mixture inhalation as well as after treatment.Mann-Whitney U test was used to compare the difference between the good and poor response subgroups.Results The scan was convenient and the imaging was good with significant contrast between tumor and the uterine myometrium [cervical cancer(15.92 ± 2.71)/s,uterine myometrium (22.76 ± 3.79)/s,t =6.474,P ＜ 0.01].Tumor R2 * values decreased after carbogen mixture gas was administrated [air:(15.92 ± 2.71) /s,carbogen:(12.44 ±2.51) /s,t =7.886,P ＜ 0.01].After treatment,tumor baseline R2* values (air inhalation) increased from 15.67 to 20.92/s (Z =-2.731,P ＜ 0.05),while the △R2 * dropped down [before treatment:2.23/s,after treatment:1.01/s,Z =-2.103,P ＜ 0.05].However,there was no significant statistical difference between the good (n =8) and poor (n =6) response subgroup after therapy in both the baseline R2 * (good response median:17.02/s,poor response median:15.19/s,Z =-1.278,P ＞ 0.05) and △R2 * (good response median:2.06/s,poor response median:2.31/s,Z =-1.670,P ＞ 0.05) of the pre-treatment scan.Conclusions The evaluation of tumor hypoxia status is essential for radiation therapy.The hypoxia related parameters R2* and △R2* derived of MR BOLD imaging can indirectly reflect the tumor oxygenation status,particularly the changes caused by the treatment.