MR表观扩散系数预测鼻咽癌放疗敏感度及相关因素分析

李伟; 彭俊琴; 李建生; 汤日杰

doi:10.3971/j.issn.1000-8578.2015.12.011

MR表观扩散系数预测鼻咽癌放疗敏感度及相关因素分析

MR Apparent Diffusion Coefficient Predicts Sensitivity of Nasopharyngeal Carcinoma to Radiotherapy and Related Factors

摘要

摘要: 目的探讨利用MR扩散加权成像的表观扩散系数（ADC值）预测鼻咽癌放疗敏感度的可行性。方法 97例鼻咽癌患者在放疗前行MR扩散加权成像检查，并测量肿瘤灶ADC值。根据放射治疗后的效果将鼻咽癌患者按放疗敏感度进行分组，放疗敏感组74例、放疗抗拒组23例。分析放疗敏感度与ADC值、病理分型、T分期的相互关系。结果放疗敏感组的ADC值为（0.792±0.121）×10^-3mm²/s，其中非角化型分化型癌23例，非角化型未分化癌51例，T1期10例，T2期33例，T3期22例，T4期9例。放疗抗拒组的ADC值为（0.730±0.104）×10^-3 mm²/s，其中非角化型分化型癌8例，非角化型未分化癌15例，T1期3例，T2期4例，T3期7例，T4期9例。两组间在ADC值、T分期方面差异均有统计学意义（t=2.199, P=0.030; χ ²=10.287,P=0.016），在病理分型方面差异无统计学意义（χ ²=0.111, P=0.740）。各T分期的ADC值整体上差异有统计学意义（F=8.597, P=0.000），随着T分期的增高，ADC值呈现下降趋势。ADC值、T分期预测鼻咽癌放疗敏感度的ROC曲线下的面积（Az）值分别为0.657、0.661。当ADC值取0.737×10^-3 mm²/s为诊断阈值时，其诊断价值最大，敏感度为68.9%，特异性为69.6%。结论 ADC值可以预测鼻咽癌放疗敏感度，其价值接近于Ｔ分期，最佳诊断阈值为0.737×10^-3 mm²/s。

Abstract: Objective To investigate the feasibility of apparent diffusion coefficient(ADC) values of MR diffusion weighted imaging in predicting the sensitivity of nasopharyngeal carcinoma to radiotherapy. Methods MR diffusion weighted imaging was performed in 97 cases of nasopharyngeal carcinoma patients before radiotherapy, and we measured the ADC values of tumor foci. According to the radiotherapy effect and sensitivity, the patients were divided into radiation sensitive group(74 cases) and radiation resistance group(23 cases), to analyze the relationship among radiotherapy sensitivity, ADC values, pathological types and T stages. Results In radiation sensitive group, the ADC value was (0.792±0.121)×10^-3mm²/s, 23 cases were non-keratinizing differentiation carcinoma, 51 cases were non-keratinizing undifferentiated carcinoma, ten cases were T1 stage, 33 cases were T2 stage, 22 cases were T3 stage and 9 cases were T4 stage. In radiation resistance group, the ADC value was (0.730±0.104)×10^-3mm²/s, eight cases were nonkeratinizing differentiation carcinoma, 15 cases were non-keratinizing undifferentiated carcinoma, three cases were T1 stage, four cases were T2 stage, seven cases were T3 stage and nine cases were T4 stage. There were significant differences in ADC values (T= 2.199, P=0.030) and T stages (χ ²=10.287, P=0.016) but no significant differences in pathological types (χ ²= 0.111, P=0.740) between two groups. There was a significant difference in ADC values among all T stages (F=8.597, P=0.000). With the increasing of T stage, the ADC value was decreased. The area under the ROC curve(Az) value of ADC value and T stage to predict the sensitivity to radiotherapy on nasopharyngeal carcinoma patients were 0.657 and 0.661. When ADC value 0.737×10-3mm2/s was taken as the diagnostic threshold, the diagnostic value was the biggest, the sensitivity was 68.9% and the specificity was 69.6%. Conclusion ADC value could predict the sensitivity of nasopharyngeal carcinoma patients to the radiotherapy. Its value is close to T stage and the best diagnostic threshold was 0.737×10^-3mm²/s.

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