影像组学评估非小细胞肺癌疗效进展

【摘要】近年来,随着非小细胞肺癌的发病率及死亡率逐年攀升,针对其的治疗方式进展迅速,包括手术切除、放化疗、免疫治疗及靶向治疗,其中放化疗仍作为治疗NSCLC的一线治疗方式。然而针对肿瘤的预后评估还停留在传统的影像学征象及实验室检查中,但从肿瘤表面得到的信息毕竟局限,准度及精度也相对较差。而影像组学可以直接观察到肿瘤内部的隐藏信息,提取到肉眼识别不到的潜在特征,填补了传统检查方式的不足。因此影像组学检测方法的出现为NSCLC的影像诊断和定性检测及疗效评价提供了新的技术手段,在其检测与定性、疗效评估等方面均具有优势。现就影像组学在非小细胞肺癌疗效评估中做一综述。     

CT新技术在肺癌早期诊断及疗效评估中的应用

影像检查在肺癌早期检测、诊断、疗效评估各个环节发挥着不可替代的作用。相较其他检查方法 ,CT检查技术因简单便捷、广泛普及与快速高效成为肺癌早期筛查、诊断、疗效评估的主要手段。简要介绍低剂量CT、高分辨增强CT、双源能谱CT、PET/CT等在肺癌早期诊断及疗效评估中的作用。基于形态与功能信息融合的CT肺癌系统评价体系,更能反映肿瘤的生物学行为特点,更符合现代肺癌治疗学的发展需求,将在肺癌精准治疗临床实践中发挥更大作用。     

肺癌PET/CT中18F-FDG摄取程度评估方法的应用研究

18F-氟脱氧葡萄糖(FDG)PET/CT作为一种无创的影像检查, 可以提供肿瘤异质性的相关信息, 因此被认为是肺癌的早期诊断、准确分期、早期疗效评估及预后评价的经典方法。以往对PET/CT中肿瘤摄取18F-FDG的评估方法通常选用半定量评估法, 其使用更加客观的参数来反映肿瘤代谢特征, 当使用半定量评估法对18F-FDG PET/CT图像进行多中心研究分析时, 很难做到对标准化摄取值的标准化, 阻碍了半定量评估法在临床实践中的广泛应用。相比之下, 视觉评估法更加简单易行, 重复性高, 不易受外界因素影响。笔者就肺癌PET/CT中18F-FDG摄取评估方法的应用及局限性进行综述。     

18F—氟脱氧葡萄糖显像在肺癌治疗中应用价值的新进展

肺癌的发病率很高,且其预后差,而传统的相关检查对肺癌的确诊、分期、监测疗效和探测肿瘤复发方面存在一定局限性.18F-氟脱氧葡萄糖显像作为一种功能影像已较广泛地应用于临床,由于其一次检查可获得全身图像且在辨别生理性摄取和病理性摄取上有明显优势,故对肺癌的淋巴结及全身远处器官转移均可从不同层面和角度进行观察,从而获得更准确的分期,影响肺癌治疗方案的制定及预后的判断.     

影像组学在肺癌中的应用研究进展

影像组学(radiomics)借助计算机软件高通量地从医学影像数据中挖掘大量的定量信息,筛选最有价值的影像组学特征来解析临床信息,指导疾病的诊疗,在肿瘤的诊断和鉴别诊断、分期分级、基因表型预测、治疗方案决策、疗效评估及预后预测等方面均显示出巨大价值.本文从影像组学概述、在肺癌中的应用研究进展、挑战及展望三方面进行论述,旨在提高对肺癌影像组学的认识.     

MRI扩散加权成像在非小细胞肺癌靶向治疗早期疗效评价中的应用价值

目的评价磁共振扩散加权成像(MRI-diffusion weighted imaging,MRI-DWI)在非小细胞肺癌靶向治疗早期疗效评价中的应用价值。 方法选择32例病理证实非小细胞肺癌患者,于治疗前、1周期靶向治疗后行胸部常规MRI检查、DWI检查及CT增强检查,以第2周期靶向治疗后相对于治疗前的肿瘤最大径变化率为标准,将患者分为有效组（19例）和无效组（13例）,比较两组治疗前后肿瘤表观扩散系数(ADC)值及最大径的差异。同时比较MRI-DWI与增强CT对肿瘤及阻塞性肺不张的显像效果。 结果肿瘤最大径在两组内不同时间及组间的差异均无统计学意义（P>0.05）。第1周期靶向治疗后,有效组肿瘤平均ADC值明显升高（×10^-3 mm²/s：1.48±0.23 vs. 1.23±0.21,t=-15.45,P<0.01）,而无效组治疗后ADC值变化不大（×10^-3 mm²/s：1.20±0.27 vs.1.15±0.32,t=-1.69,P>0.05）,并且有效组ADC值的升高率明显高于无效组（%：17.7±5.7 vs. 4.6±2.1,t=6.72,P<0.01）。CT图像可显示清楚肿瘤与不张肺组织边界6例（37.5%）,MRI-DWI图像可显示肿瘤与肺不张组织边界13例（81.3%）,高于CT图像,差异有统计学意义（χ²=6.35,P<0.05）。 结论MRI-DWI较增强CT可更清晰地显示肺不张与肺肿瘤边界,便于肿瘤大小测量及疗效评估,ADC值可以对非小细胞肺癌靶向治疗疗效做出早期监测。     

基于CT影像的人工智能在晚期非小细胞肺癌免疫治疗疗效评价中的应用进展

免疫检查点抑制剂（ICI）已成为非小细胞肺癌（NSCLC）病人的治疗方法之一,但如何筛选获益人群尚不明确。影像组学和深度学习作为人工智能分析的两大核心技术能够高通量提取和分析CT影像中的大量定量影像特征。就基于CT的影像人工智能在晚期非小细胞肺癌免疫治疗疗效评估的可行性进行综述,并对其应用前景做出展望。     

影像组学在肺癌中的研究进展

影像组学(radiomics)技术在可视化、精准定量化以及人工智能技术的推动下,高通量地从CT、MRI、PET等方面提取并分析大量高级的定量影像学数据,最终通过肿瘤异质性对肿瘤诊断及鉴别诊断、分型及分期、转移、基因表达、疗效评估以及预后等方面展现出巨大的价值,加快了肿瘤学的临床和转化研究。本文从影像组学协助肺癌诊断、评估治疗反应及预测患者预后三方面进行论述,旨在提高对肺癌影像组学的认识。     

影像组学在前列腺癌中的研究进展

影像组学可对大量的影像数据进行定量分析处理,进而量化肿瘤异质性,无创性地评估肿瘤的生物学行为,现已广泛应用于前列腺癌（PCa）的诊断与鉴别诊断、病理分级及侵袭性评估、临床决策与疗效监测以及影像基因组学等方面,对于PCa早期诊断及精准治疗起到了至关重要的作用。就影像组学在PCa中的应用进展予以综述。     

非小细胞肺癌纵隔淋巴结转移的影像学评估现状

纵隔淋巴结有无转移决定着非小细胞肺癌后续治疗方案的制定,无创性准确评估非小细胞肺癌纵隔淋巴结有无转移在临床治疗上至关重要.近年来,CT、MRI、PET/CT、支气管内镜超声、影像组学等影像检查方法对非小细胞肺癌纵隔淋巴结的转移评估都有了不同程度进展;本文对这些影像检查方法的进展进行综述,以便临床更好地选择非小细胞肺癌纵...     

18F-FDG PET/CT在肺癌疗效评估中的价值

肺癌的精准分子靶向及免疫治疗的研究和临床应用已成为当前肺癌治疗领域的热点。18F-FDG PET/CT是结合形态学与分子代谢的影像学技术,与传统的影像学检查如CT、MRI相比,18F-FDG PET/CT能够及时反映肿瘤细胞的活性,对指导肺癌的精准放化疗及监测疗效有重要价值。笔者主要就18F-FDG PET/CT在肺癌病灶的靶区勾画、疗效评估及预后评价中的价值进行探讨。     

CTPI对非小细胞肺癌通过抗血管生成治疗的评价研究

目的探讨CT灌注扫描(computed tomography perfusion imaging,CTPI)对非小细胞肺癌通过抗血管生成治疗的评价效果。方法选取本院2016年1月~2018年12月收治的100例非小细胞肺癌患者为试验组,均通过抗血管生成治疗;以同期收治的100例通过安慰剂治疗的非小细胞肺癌患者为对照组,观察治疗1个周期后两组患者CT灌注参数。结果治疗1周期后,疾病控制组灌注值、强化峰值、血容量比疾病进展组低(P<0.05),肿瘤组织最大径变化率及CT灌注参数变化率呈正相关。ROC表明:灌注值变化率对非小细胞肺癌疾病控制、疾病进展组的诊断效能最高,为99.3%,灌注值变化率对非小细胞肺癌患者疗效评价诊断的准确性比强化峰值及血容量高(P<0.05)。结论CTPI可对非小细胞肺癌抗血管生成治疗效果及患者微循环的改变进行早期反映,CT灌注参数变化率与患者病灶组织大小的变化率呈正相关,且疗效评估中灌注值变化率的效能最高。     

MR imaging in the assessment of lung cancer patients: primary lung cancer staging, evaluation of therapeutic effect and diagnosis of recurrent tumor

Magnetic resonance imaging and computed tomography were compared in a prospective study of 137 lung cancer patients proved by surgery or autopsy for determining the staging, evaluation of therapeutic effect and diagnosis of recurrent tumor. 1. Lung cancer staging In peripheral lung cancer, T1 and T2 relaxation times of the tumors before operation have some correlation with those of operated specimens. These relaxation times, however, are of limited nodule characterization. Hilar mass and adjacent pulmonary consolidation (obstructive pneumonia or collapse) can be distinguished on T2-weighted image (77%) and Gd-DTPA enhanced image (80%). Therefore these images help in distinguishing tumor from peripheral lung disease. In the diagnosis of tumor invasion to the heart and great vessels, MRI is superior to CT because MRI can be helpful in distinguishing true mass from heart and great vessels. As for the chest wall, MRI is more useful than CT in detecting tumor invasion especially to the thoracic inlet and superior regions. In the diagnosis of mediastinal and hilar lymphadenopathy, MRI is equivalent or slightly inferior to CT, but MRI can easily demonstrate the lymphadenopathy at subcarinal region on coronal image. 2. Evaluation of therapeutic effect in lung cancer patients treated by radiation and chemotherapy MRI patterns of therapeutic effect was divided into 3 types. It is suggested that there is some correlation between these patterns and histologic types. MRI can easily demonstrate necrotic area on T2-weighted and Gd-DTPA enhanced images. 3. Diagnosis of recurrent tumor in treated lung cancer Concerning detecting recurrent tumor after surgery or irradiation, and delineating tumor from radiation pneumonitis, T2-weighted and Gd-DTPA enhanced images are of clinical value.     

MR imaging of lung cancer

Since publication of the Radiologic Diagnostic Oncology Group Report in 1991, the clinical application of pulmonary magnetic resonance (MR) imaging to patients with lung cancer has been limited. Computed tomography has been much more widely available for staging of lung cancer in clinical situations. Currently, ventilation and perfusion scintigraphy is the only modality that demonstrates pulmonary function while 2-[fluorine-18]-fluoro-2-deoxy-D-glucose positron emission tomography is the only modality that reveals biological glucose metabolism of lung cancer. However, recent advancements in MR imaging have made it possible to evaluate morphological and functional information in lung cancer patients more accurately and quantitatively. Pulmonary MR imaging may hold significant potential to substitute for nuclear medicine examinations. In this review, we describe recent advances in MR imaging of lung cancer, focusing on (1) characterization of solitary pulmonary nodules; (2) differentiation from secondary change; evaluation of (3) medastinal invasion, (4) chest wall invasion, (5) lymph node metastasis, and (6) distant metastasis; and (7) pulmonary functional imaging. We believe that further basic studies, as well as clinical applications of newer MR techniques, will play an important role in the management of patients with lung cancer.     

Imaging for lung cancer restaging

Diagnostic imaging plays an important role in the monitoring of tumor response during lung cancer restaging to evaluate the efficacy of chemotherapy and/or radiation therapy during treatment, and in the detection of recurrent or metastatic neoplasm after treatment has been completed. While CT represents the primary imaging modality for lesion evaluation during restaging and for surveillance imaging once therapy has been completed, studies evaluating the role of 18-fluoro-2 deoxyglucose positron emission tomography (FDG-PET) in lung cancer restaging have shown promise regarding the detection of residual and recurrent neoplasm, and in evaluating for early response to first line therapy. With both CT and FDG-PET, residual or recurrent disease should, when possible, be differentiated from therapy-related changes in the lungs. We review the role of imaging in lung cancer restaging with attention to CT and FDG-PET for treatment assessment and the detection of recurrent or metastatic disease.     

Assessment of malignancy in pulmonary lesions: FDG dual-head coincidence gamma camera imaging in association with serum tumor marker measurement.

The purpose of the study was to evaluate the performance of dual-head coincidence gamma camera imaging using FDG in association with serum marker assays in identifying lung carcinoma in patients with abnormal findings on chest radiography. METHODS: A prospective evaluation of FDG imaging with coincidence detection emission tomography (CDET) using a dual-head gamma camera combined with the assessment of 3 sensitive serum markers of lung cancer (carcinoembryonic antigen, neuron specific enolase, and CYFRA 21-1) was performed on the same day on 58 consecutive patients with known or suspected lung malignancy. RESULTS: Fifty-three patients were proven to have lung cancer, and 5 patients had benign lung disease. Coincidence imaging showed significantly increased FDG uptake in 49 of 53 patients with proven malignancy (sensitivity, 92.5%) and in 3 patients with benign disease. FDG imaging had negative findings in 4 patients with proven malignancy and 2 patients with benign disease. Serum tumor marker levels were elevated in 42 of 53 cancer patients (sensitivity, 79.2%) and normal in 11 patients with proven malignancy. Nine patients with proven malignancy had positive findings on FDG images and negative marker assays. Two patients with proven malignancy had negative findings on FDG images and positive marker assays. The positive predictive value for lung cancer was 94.2% for FDG alone and 97.6% for FDG in association with serum markers. CONCLUSION: In this study, FDG CDET imaging was a powerful tool for evaluating patients with lung lesions suggestive of malignancy. Although the determination of serum marker levels was less accurate than FDG imaging, positive FDG results found in association with positive markers significantly increased the likelihood of lung malignancy.     

肺癌病理组织类型与影像学征象及临床表现的相关性研究

目的:探讨肺癌病理组织类型与影像学征象及临床表现的相关性。方法:回顾分析有完整临床及影像学(CT和胸片)和病理学资料的肺癌1026例。结果:在562例鳞状细胞癌中,中心型526例、周围型23例;单发530例,肺瘤界面不清456例、胸腔积液211例、肺不张或膨胀不全135例。在268例腺癌中,周围型206例,弥漫型40例,中心型22例;单发215例,肺瘤界面清晰231例。在173例小细胞肺癌中,中心型167例,弥漫型和中心型各3例;单发167例,肺瘤界面不清168例、远处转移85例。在23例大细胞肺癌中,周围型15例,中心型7例,弥漫型1例;单发18例,肺瘤界面不清晰20例。结论:肺癌的病理组织类型与影像学征象及临床表现具有相关性,通过分析影像学征象及临床表现判断肺癌的病理组织类型是可行的,对肺癌治疗方法的选择和判断预后有重要意义。     

Current status of nuclear medicine clinical application of FDG-PET for cancer diagnosis. Lung cancer

Recent advances in small cyclotrons, PET scanners, and image-processing software have made it possible to apply FDG-PET for clinical use, especially for tumor imaging. Although the efficacy of FDG-PET for several tumors remains a problem under discussion, the efficacy of PET for lung cancer has been studied in great detail and has already been established. The roles of FDG-PET for lung cancer management are, roughly speaking, 1) characterization of pulmonary nodules, 2) staging of lung cancer, 3) monitoring therapeutic effect, and 4) early diagnosis of tumor recurrence. We examined the usefulness of FDG-PET for lung cancer by analyzing our own data and reviewing recent reports. Two image-processing techniques, the image fusion technique and the respiratory-gated data-acquisition method, are also introduced in this article. FDG-PET is a promising method of anatomical imaging that is complementary to such techniques as CT and MRI. It may obtain a more important position among imaging modalities in the future.     

荧光素酶活体发光技术在肺癌分子影像学研究中的初步应用

目的 建立稳定表达荧光素酶报告基因的人肺癌细胞系,并将该肺癌细胞接种于严重联合免疫缺陷(SCID)小鼠的皮下,构建异种移植动物模型,为下一步进行肺癌进展、转移以及药物敏感性等相关的分子影像学研究奠定基础. 材料与方法 利用表达重组荧光素酶基因的慢病毒载体(Lenti-Luc)感染人肺癌细胞系NCI-H460,获得稳定表达荧光素酶基因的肺癌细胞,将该细胞接种于SCID小鼠的皮下.肿瘤细胞接种2周后,利用生物发光成像系统及MRI对肿瘤进行检测,确定肿瘤的大小和位置,并进行组织病理学检查验证. 结果 接种肺癌细胞的4只SCID小鼠中,均生长出肿瘤.生物发光检测和MRI的结果 相符,病理证实小鼠皮下肿块为癌组织. 结论 成功建立了稳定表达荧光素酶报告基因的肺癌细胞系及异种移植动物模型.荧光素酶活体发光是一种进行肿瘤分子影像学研究的重要手段.