| 基于MRI-病理对照的动态增强磁共振成像定量参数评估骨肉瘤新辅助化疗肿瘤坏死率的价值 |
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| 引用本文： | 王瑶,李佳璐,马焕,李鹍,王洪波,丁莹莹,陶海波,李梅. 基于MRI-病理对照的动态增强磁共振成像定量参数评估骨肉瘤新辅助化疗肿瘤坏死率的价值[J]. 中国肿瘤临床, 2022, 49(19): 988-993. DOI: 10.12354/j.issn.1000-8179.2022.20220243 |
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| 作者姓名： | 王瑶 李佳璐 马焕 李鹍 王洪波 丁莹莹 陶海波 李梅 |
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| 作者单位： | 1.昆明医科大学第三附属医院/云南省肿瘤医院放射科（昆明市 650018） |
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| 基金项目： | 本文课题受云南省基础研究计划昆医联合专项项目（编号:2019FE001-079,2019FE001-240）资助 |
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| 摘 要： | 目的 基于MRI-病理对照,探讨动态增强磁共振成像（dynamic contrast-enhanced magnetic resonance imaging,DCE-MRI）定量参数评估骨肉瘤新辅助化疗（neoadjuvant chemotherapy,NAC）肿瘤坏死率的价值。 方法 收集2019年1月至2020年6月于昆明医科大学第三附属医院收治的膝关节周围骨肉瘤患者11例,于NAC前、后行常规MRI及矢状位DCE-MRI检查。NAC疗程结束后两周内经外科手术获取完整肿瘤瘤段,沿正中矢状面剖开,取厚度为5 mm病理切片并分割成大小为1 cm×1 cm的若干组织块,编号后作为与影像对照的病理样本。依靠解剖标志,确定与病理切片对应的DCE-MRI影像层面,将病灶划分为1 cm×1 cm大小感兴趣区（region of interest,ROI）,并进行化疗前、后影像ROI与病理样本匹配。采用Omni Kinetics软件测量化疗前定量参数-pre-Ktrans、pre-Kep、pre-Ve、pre-Vp和化疗后参数-post-Ktrans、post-Kep、post-Ve、post-Vp,并计算化疗前-后各参数差值?Ktrans、?Kep、?Ve、?Vp。采用Huvos分级标准检测每个病理样本肿瘤坏死率（tumor necrosis rate,TNR）,并划分为缓解组（TNR≥90%）和未缓解组（TNR<90%）。采用Mann-Whitney U检验,比较两组病理样本NAC前、后各定量参数是否存在差异。采用ROC曲线,比较NAC后DCE-MRI定量参数及治疗前后的差值预测NAC后TNR的效能。 结果 入组骨肉瘤11例,共取得304个病理样本,其中缓解组59个（19.4%）,未缓解组245个（80.6%）。两组化疗后Ktrans、Ve、Vp均明显降低,且未缓解组参数值明显低于缓解组（P<0.05）;化疗后缓解组Kep明显升高（P<0.05）,但未缓解组Kep无差异（P>0.05）。两组化疗前后参数差值ΔKtrans、ΔVe、ΔVp差异无统计学意义（P>0.05）,但缓解组ΔKep明显低于未缓解组（P<0.05）。ROC曲线分析结果,化疗后定量参数诊断TNR缓解效能优于化疗前-后差值,其中post-Ktrans诊断效能最高,诊断阈值为0.663/min、AUC为0.745、灵敏度为89.83%、特异性为52.24%。 结论 DCE-MRI定量参数在评估骨肉瘤新辅助化疗TNR有一定的应用价值,具有即时、无创反映NAC疗效的应用潜力。
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| 关 键 词： | 骨肉瘤 新辅助化疗 动态增强磁共振成像 肿瘤坏死率 |
| 收稿时间： | 2022-02-15 |
Evaluation of tumor necrosis rate of osteosarcoma after neoadjuvant chemotherapy using quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging based on MRI-pathological correlation |
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| Affiliation: | 1.Department of Radiology, The Third Affiliated Hospital of Kunming Medical University, Kunming 650018, China2.Department of Radiology, Hangzhou Medical College Affiliated Lin'an People's Hospital, Hangzhou 310000, China3.Department of Pathology, The Third Affiliated Hospital of Kunming Medical University, Kunming 650018, China |
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| Abstract: | Objective To assess the value of quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) in determining tumor necrosis rates (TNRs) of osteosarcoma after neoadjuvant chemotherapy (NAC) based on MRI-pathological correlation. Methods Patients with osteosarcoma that occurred around the knee from January 2019 to June 2020 were examined at The Third Affiliated Hospital of Kunming Medical University using conventional MRI and sagittal DCE-MRI before and after NAC. The whole tumor segment was obtained during surgery within 2 weeks after administering NAC. The tumor segments were cut along the median sagittal plane. Next, 5 mm-thick histopathological sections were sliced and divided into tissue blocks measuring 1 cm×1 cm in size and numbered as the specimens compared with the images. The lesion on DCE-MRI before and after NAC corresponding to the median sagittal histopathological section was also divided into the region of interest (ROI) measuring 1 cm×1 cm in size and matched with specimens. The quantitative parameters before (pre-Ktrans, pre-Kep, pre-Ve, pre-Vp) and after NAC (post-Ktrans, post-Kep, post-Ve, post-Vp) were measured using the Omni Kinetics software, and changes in parameters (?Ktrans, ?Kep, ?Ve, ?Vp) were also assessed. The tumor necrosis rate (TNR) of each specimen was determined using the Huvos grading system, and the patients were categorized into the responsive group (TNR ≥90%) and unresponsive group (TNR <90%). Mann-Whitney U test was used to compare quantitative parameters before and after NAC between the two groups. ROC curve analysis was performed to compare the efficiency of quantitative parameters of DCE-MRI to predict TNR. Results Eleven patients with osteosarcoma were enrolled, and 304 specimens were obtained, including 59 (19.4%) in the responder group and 245 (80.6%) in the non-responder group. After NAC, Ktrans, Ve, and Vp significantly decreased in both groups, and the parameters of the responder group were significantly lower than those of the non-responsive group (P<0.05). Kep significantly increased in the responder group (P<0.05), with no significant difference in the non-responder group before and after NAC (P>0.05). There was no significant difference in the parameters ΔKtrans, ΔVe, and ΔVp between the two groups (P>0.05); however, ΔKep was significantly lower in the responder group than in the non-responder group (P<0.05). Receiver operating characteristic (ROC) curve analysis revealed that the efficacy of quantitative parameters after NAC was better than the changes in parameters, and post-Ktrans had the highest diagnostic efficiency, with the most optimal cut-off of 0.663/min, AUC of 0.744, sensitivity of 89.83%, and specificity of 52.24% for predicting TNR of osteosarcomas after NAC. Conclusions DCE-MRI parameters, especially Ktrans, had a potential for evaluating TNR of osteosarcoma after NAC in a timely and non-invasive manner. |
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