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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

李伟, 彭俊琴, 李建生, 汤日杰. MR表观扩散系数预测鼻咽癌放疗敏感度及相关因素分析[J]. 肿瘤防治研究, 2015, 42(12): 1221-1226. DOI: 10.3971/j.issn.1000-8578.2015.12.011
引用本文: 李伟, 彭俊琴, 李建生, 汤日杰. MR表观扩散系数预测鼻咽癌放疗敏感度及相关因素分析[J]. 肿瘤防治研究, 2015, 42(12): 1221-1226. DOI: 10.3971/j.issn.1000-8578.2015.12.011
LI Wei, PENG Junqin, LI Jiansheng, TANG Rijie. MR Apparent Diffusion Coefficient Predicts Sensitivity of Nasopharyngeal Carcinoma to Radiotherapy and Related Factors[J]. Cancer Research on Prevention and Treatment, 2015, 42(12): 1221-1226. DOI: 10.3971/j.issn.1000-8578.2015.12.011
Citation: LI Wei, PENG Junqin, LI Jiansheng, TANG Rijie. MR Apparent Diffusion Coefficient Predicts Sensitivity of Nasopharyngeal Carcinoma to Radiotherapy and Related Factors[J]. Cancer Research on Prevention and Treatment, 2015, 42(12): 1221-1226. 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

基金项目: 广州市医药卫生科技项目(20141A011093)
详细信息
    作者简介:

    李伟(1978-),男,硕士,主治医师,主要从事肿瘤影像学的研究

  • 中图分类号: R739.63

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

  • 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.

     

  • [1] Koh DM, Collins DJ. Diffusion-weighted MRI in the body: applications and challenges in oncology[J]. AJR Am J Rocentgenol, 2007, 188(6): 1622-35.
    [2] Li W, Lu BG, Fu WH, et al. The value of multi-slice spiral CT in the follow-up of the patients with nasopharyngeal carcinoma[J]. Guangdong Yi Xue, 2012, 33(2): 231-3. [李伟, 卢斌贵, 傅文 海, 等. 多层螺旋CT在鼻咽癌预后随访中的价值[J]. 广东医学, 20 12, 33(2): 231-3.]
    [3] Pan JJ, Zong JF. consideration of multi-disciplinary treatment strategy in the mode of IMRT for NPC[J]. Zhongguo Zhong Liu Lin Chuang, 2012, 39(24): 1989-92. [潘建基, 宗井凤. 调强放射 治疗模式下鼻咽癌的多学科治疗策略的思考[J]. 中国肿瘤临 床, 2012, 39(24): 1989-92.]
    [4] Bammer R. Basic principles of diffusion-weighted imaging [J]. Eur J Radiol, 2003, 45(3): 169-84.
    [5] Li W, Lu BG, Fu WH, et al. The value of DWI in differential diagnosing benign and malignant nasopharyngeal lesions[J]. Zhongguo Lin Chuang Yi Xue Ying Xiang Za Zhi, 2014, 25(11): 13 -6. [李伟, 卢斌贵, 傅文海, 等. 鼻咽黏膜DWI影像特点对于 鼻咽良恶性病变判断的价值[J]. 中国临床医学影像杂志, 2014, 25 (11): 13-6.]
    [6] Chen YB, Mao Y, Pan JJ, et al. Clinical study of diffusion weighted imaging in nasopharyngeal carcinoma[J]. Zhonghua Fang She Zhong Liu Xue Za Zhi, 2009, 18(2): 88-91. [陈韵彬, 毛瑜, 潘建 基, 等. 鼻咽癌弥散加权成像临床研究[J]. 中华放射肿瘤学杂 志, 2009, 18(2): 88-91.]
    [7] Wan DS. Clinical Oncology[M]. 2nd ed. Beijing: Scientific Publication, 2007: 134-46. [万德森. 临床肿瘤学[M]. 2版.北京: 科学出版社, 2007: 134-46.]
    [8] Wen G, Huang XB, Zhang WD, et al. Primary exploration of individual biological boosting target volume for locally advanced nasopharyngeal carcinoma[J]. Zhonghua Yi Xue Za Zhi, 2012, 92 (45): 3207-10. [温戈, 黄晓波, 张卫东, 等. 局部晚期鼻咽癌 个体化生物加量靶区探讨[J]. 中华医学杂志, 2012, 92(45): 32 07-10.]
    [9] Zhao WY, Sun XC. Progression of tumor radiosensitization[J]. Lin Chuang Zhong Liu Xue Za Zhi, 2012, 17(7): 655-9. [赵维勇, 孙新臣. 放射治疗增敏的研究现状[J]. 临床肿瘤学杂志, 2012, 17 (7): 655-9.]
    [10] Xie P, Hu M, Yu JM. Research progress of hypoxia imaging in tumor radiotherapy[J]. Zhonghua Zhong Liu Xue Za Zhi, 2009, 31 (3): 161-3. [谢鹏, 胡漫, 于金明. 肿瘤放射治疗中乏氧显像的 研究进展[J]. 中华肿瘤学杂志, 2009, 31(3): 161-3.]
    [11] Hong J, Yao Y, Zhang Y, et al. Value of magnetic resonance diffusion-weighted imaging for the prediction of radiosensitivity in nasopharyngeal carcinoma [J]. Otolarngol Head Neck Surg, 20 13, 149(5): 707-13.
    [12] Lin M, Yu XD, Luo DH, et al. Pretreatment MR diffusion weighted imaging predicts the sensitivity of concurrent chemoradiation in nasopharyngeal carcinoma[J]. Zhonghua Fang She Xue Za Zhi,2014, 48(6): 467-71. [林蒙, 余小多, 罗德红, 等. MR扩散加权成 像预测鼻咽癌患者同步放化疗疗效的可行性[J]. 中华放射学杂 志, 2014, 48(6): 467-71.]
    [13] Yu XP, Li FP, Lu Q, et al. Correlation of MRI perfusion quantitative parameters and ADC value with the T stage of nasopharyngeal carcinoma[J]. Fang She Xue Shi Jian, 2014, 29 (11): 1282-5. [于小平, 李飞平, 卢强, 等. 鼻咽癌磁共振灌 注定量参数及ADC值与T分期的关系[J]. 放射学实践, 2014, 29 (11): 1282-5.]
    [14] Zhu PY, Zhou W, Huang XY. The diagnostic value of MR diffusion weighted imaging in benign and malignant lesions of the nasopharynx and nasopharyngeal T staging[J]. Zhongguo Xian Dai Yi Sheng, 2014, 52 (36): 55-8. [朱培杨, 周玮, 黄小燕. MR扩 散加权成像在鼻咽良恶性病变及鼻咽癌T分期中的诊断价[J]. 中国现代医生, 2014, 52(36): 55-8.]
    [15] Li W, Duan GF, Tang RJ. The relationship between CT enhancement degree and T stage in nasopharyngeal carcinoma[J]. Guangdong Yi Xue, 2012, 33(6): 773-5. [李伟, 段光峰, 汤日杰. 鼻咽癌CT强化程度与T分期的关系[J]. 广东医学, 2012, 33(6): 77 3-5.]
    [16] Hou QL. Value of MSCT Perfusion Scanning for Predicting the Radiosensitivity of Neck Lymph Node Metastasis in Nasopharyngeal Carcinoma[J]. Yi Xue Lin Chuang Yan Jiu, 2010, 27 (8): 1439-43. [侯启龙. MSCT灌注扫描在鼻咽癌颈部转移淋 巴结放疗敏感性预测中的价值[J]. 医学临床研究, 2010, 27(8): 14 39-43.]
    [17] Li J. Pan YD, Yin JL, et al. Analysis of standard uptake values of 18 F-FDG PET/CT in relation to pathological classification and clinical staging of nasopharyngeal carcinoma[J]. Nan Fang Yi Ke Da Xue Xue Bao, 2008, 28(10): 1923-4. [黎静, 潘艳东, 尹吉林, 等. 18F-FDG PET/CT标准化摄取值与鼻咽临床分期和病理类 型的关系[J]. 南方医科大学学报, 2008, 28(10): 1923-4.]
    [18] Li H, Xie CM. Liu XW, et al. Comparative study of diffusion weighted imaging and PET-CT in the diagnosis of nasopharyngeal carcinoma[J]. Zhonghua Zhong Liu Xue Za Zhi, 33(10): 791-2. [李 卉, 谢传淼, 刘学文, 等. 弥散加权成像与PET-CT对鼻咽癌诊断 效力的比较研究[J]. 中华肿瘤学杂志, 2011, 33(10): 791-2.]
    [19] Zheng YJ, Zhao C, Fan W, et al. The atudy of hypoxia status of the primary lesion of nasoparyngeal carcinoma with 99Tcm-HL91 imaging[J].Zhonghua He Yi Xue Za Zhi, 2008, 28(2): 100-2. [郑 颖洁, 赵充, 樊卫, 等. 99Tcm-HL91显像评价鼻咽癌放疗前原发 灶乏氧状况[J]. 中华核医学杂志, 2008, 28(2): 100-2.]
    [20] Eschmann SM, Paulsen F, Reimold M, et al. Prognostic impact of hypoxia imaging with 18F-misonidazole PET in non-small cell lung cancer and head neck cancer before radiotherapy[J]. J Nucl Med, 2005, 46(2): 253-60.
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出版历程
  • 收稿日期:  2015-01-27
  • 修回日期:  2015-03-17
  • 刊出日期:  2015-12-24

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