CAJ | 학술논문

目的探讨DWI在预测及早期评价食管癌同期放化疗短期疗效中的可行性及应用价值.方法搜集40例经病理证实并行同期放化疗食管癌患者,治疗前后不同时间点行DWI检查.应用RECIST标准进行短期疗效评价,分为缓解组(CR、PR)和未缓解组(SD、PD).组间比较行成组t检验,对治疗后不同时间点肿瘤ADC值变化率行ROC曲线分析.结果缓解组、未缓解组分别为30、10例.缓解组在治疗第1周末ADC值升高程度高于未缓解组(P=0.000).缓解组、未缓解组治疗1周末肿瘤最大径与疗前均相近(66.10 mm∶62.63 mm,P=0.407;70.90 mm∶ 68.30 mm,P=0.552).肿瘤治疗前ADC值与肿瘤最大径缩小率间呈负相关(r=-0.680,P=0.000).肿瘤治疗后第1周末ROC曲线下面积最大为0.783,ADC值变化率为15.5％作为判断治疗是否有效的敏感性为86.7％、特异性为70.0％、阳性预测值为89.7％、阴性预测值为63.6％.结论 DWI可作为一种预测及评价食管癌同期放化疗短期疗效的新的影像学方法,以治疗1周末ADC值变化率对区分治疗反应较敏感,可以作为有效监测时间点.
목적 탐토DWI재예측급조기평개식관암동기방화료단기료효중적가행성급응용개치.방법 수집40례경병리증실병행동기방화료식관암환자,치료전후불동시간점행DWI검사.응용RECIST표준진행단기료효평개,분위완해조(CR、PR)화미완해조(SD、PD).조간비교행성조t검험,대치료후불동시간점종류ADC치변화솔행ROC곡선분석.결과 완해조、미완해조분별위30、10례.완해조재치료제1주말ADC치승고정도고우미완해조(P=0.000).완해조、미완해조치료1주말종류최대경여료전균상근(66.10 mm∶62.63 mm,P=0.407;70.90 mm∶ 68.30 mm,P=0.552).종류치료전ADC치여종류최대경축소솔간정부상관(r=-0.680,P=0.000).종류치료후제1주말ROC곡선하면적최대위0.783,ADC치변화솔위15.5％작위판단치료시부유효적민감성위86.7％、특이성위70.0％、양성예측치위89.7％、음성예측치위63.6％.결론 DWI가작위일충예측급평개식관암동기방화료단기료효적신적영상학방법,이치료1주말ADC치변화솔대구분치료반응교민감,가이작위유효감측시간점.
Objective To investigate the feasibility and value of diffusion-weighted imaging (DWI) in the prediction and early assessment of response to concurrent chemoradiotherapy (CCRT) for esophageal cancer.Methods A total of 40 patients with pathologically confirmed esophageal cancer who received CCRT were included in the study.Routine 3.0 T MRI and DWI were performed at different time points of treatment.The RECIST standard was adopted to evaluate short-term outcomes and divide the patients into remission group (complete remission and partial remission) and non-remission group (stable disease and progressive disease).Group t-test was used for between-group comparison.The receiver operating characteristic (ROC) curve was used to analyze the change rates of apparent diffusion coefficient (ADC) value at different time points of treatment.Results There were 30 patients in the remission group and 10 patients in the non-remission group.The remission group had a significantly higher increase in ADC value than the non-remission group by the end of the first week of treatment (P =0.000).The maximum diameters of tumors for the emission group and non-remission group at the end of the first week of treatment were not significantly different from those before treatment (66.10 mm vs.62.63 mm,P =0.407 ; 70.90 mm vs.68.30 m,P =0.552).The ADC value before treatment had a negative correlation with the reduction rate of the maximum diameter of tumor (r =-0.680,P =0.000).The area under the ROC curve was the largest at the end of the first week of treatment (Az =0.783).If using 15.5 ％ increase in ADC value by the end of the first week as the threshold value for evaluating tumor response,the sensitivity,specificity,positive predictive value,and negative predictive value were 86.7％,70.0％,89.7％,and 63.6％,respectively.Conclusions DWI can be used as a new imaging method for the prediction and early assessment of the response to CCRT for esophageal cancer.The change rate of ADC value by the end of the first week of treatment is sensitive in assessing treatment response,so ADC value can be monitored at this time point.