CAJ | 학술논문

目的：探讨多期动态增强磁共振成像（ DCE-MRI）半定量和定量参数在评价非小细胞肺癌（ NSCLC）同步放化疗敏感性中的作用。方法对24例经病理证实为局部晚期NSCLC（ⅢA、ⅢB期）、拟行同步放化疗的患者，于治疗前行3．0 T多期DCE-MRI扫描。应用Functool和Omnikinetics软件计算DCE-MRI半定量参数和定量参数。采用Spearman等级相关分析评价各参数与治疗终肿瘤消退率的相关性。根据治疗终肿瘤退缩率将患者分为治疗敏感组和不敏感组，比较敏感组和不敏感组治疗前半定量和定量参数的差异。应用受试者工作特征曲线分析治疗前参数的临界值和效能。结果NSCLC治疗终肿瘤消退率与达峰时间（TTP）、血管外细胞外间隙容积比（Ve）呈负相关（均P＜0．05），与最大信号增强比率（SER max ）、容量转移常数（ Ktrans ）呈正相关（均P＜0．05）。敏感组TTP和Ve 值分别为（34．66±16．37）s 和0．19±00．3，不敏感组分别为（44．09±17．41）s和0．25±0．05，差异均有统计学意义（均P＜0．05）。敏感组SERmax和Ktrans 分别为（166．50±44．95）％和（0．41±0．17） min－1，不敏感组分别为（113．57±46．62）％和（0．28±0．12） min－1，差异均有统计学意义（均P＜0．05）。以肿瘤治疗前V e 值0．21为临界值，预测同步放化疗敏感性最佳，其敏感度、特异度和准确性分别为85．7％、80．0％和83．3％，曲线下面积为0．875（ P＜0．001）。结论 DCE-MRI半定量参数与定量参数均有助于评价非小细胞肺癌消退情况。
목적：탐토다기동태증강자공진성상（ DCE-MRI）반정량화정량삼수재평개비소세포폐암（ NSCLC）동보방화료민감성중적작용。방법대24례경병리증실위국부만기NSCLC（ⅢA、ⅢB기）、의행동보방화료적환자，우치료전행3．0 T다기DCE-MRI소묘。응용Functool화Omnikinetics연건계산DCE-MRI반정량삼수화정량삼수。채용Spearman등급상관분석평개각삼수여치료종종류소퇴솔적상관성。근거치료종종류퇴축솔장환자분위치료민감조화불민감조，비교민감조화불민감조치료전반정량화정량삼수적차이。응용수시자공작특정곡선분석치료전삼수적림계치화효능。결과NSCLC치료종종류소퇴솔여체봉시간（TTP）、혈관외세포외간극용적비（Ve）정부상관（균P＜0．05），여최대신호증강비솔（SER max ）、용량전이상수（ Ktrans ）정정상관（균P＜0．05）。민감조TTP화Ve 치분별위（34．66±16．37）s 화0．19±00．3，불민감조분별위（44．09±17．41）s화0．25±0．05，차이균유통계학의의（균P＜0．05）。민감조SERmax화Ktrans 분별위（166．50±44．95）％화（0．41±0．17） min－1，불민감조분별위（113．57±46．62）％화（0．28±0．12） min－1，차이균유통계학의의（균P＜0．05）。이종류치료전V e 치0．21위림계치，예측동보방화료민감성최가，기민감도、특이도화준학성분별위85．7％、80．0％화83．3％，곡선하면적위0．875（ P＜0．001）。결론 DCE-MRI반정량삼수여정량삼수균유조우평개비소세포폐암소퇴정황。
Objective To investigate the capability of semi-quantitative and quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging ( DCE-MRI) to predict the response to concurrent chemoradiotherapy( CCRT) in patients with non-small cell lung cancer ( NSCLC) .Methods A total of 24 patients with stageⅢA orⅢB NSCLC, who underwent 3.0T DCE-MRI before CCRT, were enrolled in this study.Semi-quantitative and quantitative parameters were calculated by Funtool and Omnikinetics software. The relationship between these obtained parameters and tumor response was evaluated by Spearmen′s correlation analysis.The patients were classified into two groups according to the tumor regression rate after treatment, as response group ( group A) and non-response group ( group B) .Mann-Whitney U test was used to compare the parameters of responders and non-responders.The value of the parameters on predicting response was calculated by receiver operating characteristic curve (ROC).Results The tumor regression rate after treatment was negatively correlated with time to peak ( TTP ) and the extravascular-extracellular volume fraction ( Ve ) , and was positively correlated with signal enhancement ratio ( SERmax ) and volume transfer constant (Ktrans)(P<0.05 for all).Statistical significant differences were found between group A and group B both in semi-quantitative and quantitative parameters ( P<0.05) .Group A had a lower TTP value [(34.66±16.37)s vs.(44.09±17.41)s] and Ve value [(0.19±0.03) vs.(0.25±0.05)] than group B, whereas group A had a higher SERmax[(166.50±44.95)%vs.(113.57±46.62)%] and Ktrans[(0.41±0.17) min-1 vs.(0.28±0.12) min-1] than group B (P<0.05 for all).The ROC analysis indicated that when setting the threshold of Ve on≤0.21 for predicting response, the specificity, sensitivity and accuracy were 85 .7%, 8 0 .0%and 8 3 .3%, respectively , with an area under curve of 0 .8 7 5 ( P<0 .0 0 1 ) .Conclusions Both the semi-quantitative and quantitative DCE-MRI parameters are helpful for predicting the response after CCRT of NSCLC.Quantitative parameters seem to be more meaningful than semi-quantitative parameters.