IVIMMRI评估宫颈癌同步放化疗疗效探讨

目的 使用IVIMMRI研究宫颈癌的组织学特性，并探讨IVIMMRI在中晚期宫颈癌放化疗疗效评估中的应用价值。方法 对23例经病理证实为中晚期(≥Ⅱ_b期)宫颈癌患者分别于放化疗前、治疗后2周、4周及结束时行盆腔MRI扫描，包括T₂WI、IVIM (14个b值，范围0~1 000 s/mm²)及T₁增强扫描。IVIMMRI数据使用双指数模型分析获得纯扩散系数(D)、伪扩散系数(D*)和灌注分数(f)，使用单指数模型测量ADC值。分别测量各检查点肿瘤IVIMMRI相关参数，分析其动态变化及相关性。结果 治疗结束时比治疗前ADC值、D值、f值均下降，分别为0.96×10^-3 mm²/s∶1.77×10^-3 mm²/s (P=0.000)、0.76×10^-3 mm²/s∶1.34±0.12×10^-3 mm²/s (P=0.000)、0.14%∶0.24%(P=0.012);治疗后第2周3个参数值明显升高(所有P=0.000)，一直持续至治疗结束。D*值在治疗结束时呈下降趋势。结论 IVIMMRI可以监测宫颈癌放化疗过程中动态变化，并可早期反应其变化，具有临床应用价值。

Intravoxel incoherent motion magnetic resonance imaging for evaluation of the efficacy of concurrent chemoradiotherapy in treatment of cervical cancer

Objective To assess the histological characteristics of cervical cancer using intravoxel incoherent motion magnetic resonance imaging (IVIMMRI) and to investigate the performance of IVIMMRI in evaluation of the efficacy of concurrent chemoradiotherapy in the treatment of intermediate/advanced cervical cancer. Methods Pelvic MRI scans, containing T₂WI, IVIM (14 b values, b=0-1 000 s/mm²), and contrast-enhanced T₁ scans were performed in 23 patients pathologically diagnosed with intermediate/advanced cervical cancer (stage ≥Ⅱ_b) before chemoradiotherapy, after two and four weeks of treatment, and at the end of treatment. The IVIMMRI data were processed with the bi-exponential model to generate three parameters, containing pure diffusion coefficient (D), pseudodiffusion coefficient (D*), and perfusion fraction (f). Apparent diffusion coefficient (ADC) was obtained using the mono-exponential model. The IVIMMRI parameters were measured at each time point and their dynamics and correlation were analyzed. Results The ADC, D, and f values were significantly higher after complete treatment (0.96×10^-3 vs. 1.77×10^-3 mm²/s, P=0.000;0.76 ×10^-3 vs. 1.34±0.12×10^-3 mm²/s, P=0.000;0.14% vs. 0.24%, P=0.012). The above three values significantly increased after two weeks of treatment (all P=0.000) and kept increasing until the end of the treatment. In contrast, the D* value was reduced from the second week to the end of the treatment. Conclusions IVIMMRI can monitor the dynamic functional changes and early tumor responses during chemoradiotherapy for cervical cancer, which holds promise for clinical application.