DCE-MRI半定量参数预测和监测喉癌和下咽癌同步放化疗疗效的价值

目的 探讨动态增强磁共振成像(DCE-MRI)相关半定量参数对喉癌和下咽癌同步放化疗疗效的预测和监测作用.方法 收集44例喉癌和下咽癌初诊患者,活检病理均为鳞状细胞癌,于治疗前、治疗中、治疗末行常规MRI及DCE-MRI扫描,获得肿瘤的时间-信号强度曲线(TIC)及相关半定量参数.于治疗末判断肿瘤缓解情况,并利用SPSS进行统计学分析.结果 治疗末完全缓解(CR)组22例,部分缓解(PR)组22例.治疗中达峰时间(TTP)、最大信号增强比率(SERmax)、正性增强积分(PEI)、注射对比剂后70 s、84 s的信号增强比率(SER70、SER84)较治疗前升高,差异有统计学意义(P<0.05).CR组治疗前SERmax、SER42、SER56、SER70、SER84较PR组高,差异有统计学意义(P<0.05).受试者工作特征(ROC)曲线分析结果显示以治疗前SER56≥129.4％预测肿瘤CR情况,其敏感性和特异性分别为60％、86.4％.不同TIC类型完全缓解率比较结果显示TICⅠ型较Ⅲ型完全缓解率高,分别为87.5％、39.3％,差异有统计学意义(P=0.041).结论 TIC类型及DCE-MRI相关半定量参数可预测喉癌及下咽癌同步放化疗疗效,半定量参数中以SER56预测价值最大,疗前TICⅠ型较Ⅲ型预后好.

The value of semiquantitative parameters of DCE-MRI in predicting and monitoring efficacy of concurrent chemoradiotherapy in laryngeal and hypopharyngeal carcinoma

Objective To evaluate the value of semi-quantitative parameters of dynamic contrast-enhanced MRI (DCE-MRI)in predicting and monitoring therapeutic efficacy of concurrent chemoradiotherapy in laryngeal and hypopharyngeal carcinoma.Methods Forty-four patients with pathologically confirmed laryngeal and hypopharyngeal squamous cell carcinoma were collected.Time signal intensity curves (TIC)and related semi-quantitative parameters were obtained before (point 1 ),during (point 2)and after (point 3 )treatment. Tumor remission were assessed at the end of treatment and the statistical analyses were performed using SPSS.Results Twenty two patients had a complete remission as CR group and 22 had a partial remission as PR group.The parameters of time to peak (TTP), maximum signal enhancement ratio (SERmax ),positive enhancement integral (PEI),SER70 and SER84 at point 1 were higher than those at point 2,and there were significant differences between two groups (P <0.05).The values of SERmax ,SER42 ,SER56 ,SER70 and SER84 before treatment were higher in CR group than those in PR group,exhibiting significant differences between two groups (P <0.05).ROC curve analysis showed the threshold for SER56 was set to ≥129.4％ to predict complete remission,and the sensitivity and specificity were 60％ and 86.4％,respectively.Comparison of remission rates among different types of TIC showed complete remission rates in typeⅠTIC and type Ⅲ TIC were 87.5％ and 39.3％,respectively,exhibiting a significant difference between two groups (P =0.041). Conclusion TIC types and semi-quantitative parameters of DCE-MRI can predict therapeutic efficacy of concurrent chemoradiotherapy in laryngeal and hypopharyngeal carcinoma,SER56 is the most important predictive semi-quantitative parameter,and prognosis is much better in typeⅠTIC than type Ⅲ TIC before treatment.