扩散加权成像对原发性中枢神经系统淋巴瘤放疗疗效的预测价值

目的 探讨扩散加权成像（DWI）对原发性中枢神经系统淋巴瘤（PCNSL）疗效预测价值。方法 选择2010年3月至2013年12月太和县人民医院和中国人民解放军第105医院经临床和病理证实的28例PCNSL，测肿瘤最小表观扩散系数值（ADC_min）、最大ADC值（ADC_max）及平均ADC值（ADC_mean），分析不同ADC值间无进展生存期（PFS）的差异。放疗后即刻评估疗效，将患者分为初始疗效完全缓解组（CR_i）和部分缓解组（PRi），比较组间各指标的差异。结果 CR_i者（P=0.031）、低Ki-67表达（P=0.008）、高KPS（P=0.031）、高ADC_min（P=0.031）或者ADC_mean（P=0.003）有较好PFS，年龄、强化灶数目、性别不影响PFS。CR_i与PR_i患者的PFS、KPS、ADC_min、ADC_mean差异有统计学意义（P<0.05）。结论 DWI可预测PCNSL放疗反应性和PFS。

Predictive value of pretherapeutic DWI in radiotherapy efficacy of primary central nervous system lymphoma

Objective To investigate whether the apparent diffusion coefficient(ADC) value derived from pretherapeutic diffusion-weighted imaging(DWI) in primary central nervous system lymphoma(PCNSL) was a prognostic indicator reflecting both progression-free survival(PFS) and response to radiotherapy.Methods Retrospective observation of clinical characteristics and findings of pretherapeutic DWI were carried out in 28 patients with PCNSL received radiotherapy. Maximum(ADC_max), minimum (ADC_min), and the average of mean (ADC_mean) ADC values of the enhancing tumor volume were measured. The difference of PFS was investigated bychi-square test about potential prognostic parameters. Various ADC values and clinical features were analyzed using an independent sample t-test between initial complete response(CR_i) and initial partial response(PR_i) groups at the end of radiotherapy. Results Patients with CR_i, lower Ki-67 level, higher Karnofsky performance status(KPS), higher ADC_min or ADC_mean showed better PFS. PFS was not correlated with age, number of intensified foci and gender. There was a significant difference in PFS, KPS, ADC_mean and ADC_min between CR_i and PR_i. Conclusion ADC measurements are useful predictors for PFS and response to radiotherapy in PCNSL.