ADC值评价骨肉瘤新辅助化疗后坏死的价值

目的:通过病理学对照研究,探讨ADC值评价骨肉瘤新辅助化疗后坏死的价值。方法:12例行新辅助化疗的原发四肢骨肉瘤患者,在其完成新辅助化疗后且手术前3天内同时行常规MRI和DWI检查。参照MRI和ADC图表现,在术后大体标本相应区取材,获取骨外软组织肿块127个区,分析不同ADC值的病理基础。结果:非软骨性肿瘤存活区、软骨性肿瘤存活区、非软骨性肿瘤坏死区、肿瘤坏死后胶原化区、肿瘤坏死囊变血腔及继发动脉瘤样骨囊肿区ADC值分别约(1219.63±26.73)×10-6 mm2/s、(2193.21±37.87)×10-6 mm2/s、(1770.52±33.41)×10-6 mm2/s、(2287.36±39.34)×10-6 mm2/s和(2293.57±50.36)×10-6 mm2/s。非软骨性肿瘤存活区与其它4区、非软骨性肿瘤坏死区与其它4区ADC值之间差异均有统计学意义(P<0.001),软骨性肿瘤存活区、肿瘤坏死后胶原化区、肿瘤坏死囊变血腔及继发动脉瘤样骨囊肿区ADC值之间差异均无统计学意义(P>0.05)。结论:ADC值在判定骨肉瘤化疗后坏死时,会受到存活的软骨性肿瘤成分的影响;借助ADC值可鉴别骨肉瘤化疗后非软骨性肿瘤细胞的存活、坏死和瘤细胞外间质改变。

The value of ADC in determining osteosarcoma necrosis after neoadjuvant chemotherapy

Objective：To study the value of ADC in determining osteosarcoma necrosis after neoadjuvant chemotherapy.Methods：12 patients with histologically proven primary limb bone osteosarcoma all underwent MRI and DWI scanning after neoadjuvant chemotherapy and three days before limb resection.A comparative study between histopathologic findings and DWI features was performed in 127 specimens from soft-tissue mass around affected bone in order to investigate histopathologic features of different ADC regions.Results：The mean ADC values in non-cartilaginous tumor survival region,cartilaginous tumor survival region,non-cartilaginous tumor necrosis region,tumor post-necrosis collagen region,cystic necrosis hemocoele and secondary aneurysmal bone cysts region were（1219.63±26.73）×10-6,（2193.21±37.87）×10-6,（1770.52±33.41）×10-6,（2287.36±39.34）×10-6 and（2293.57±50.36）×10-6mm2/s,respectively.The difference in ADC was statistically significant（P0.001） between the non-cartilaginous tumor survival region and the other four regions,also between the non-cartilaginous tumor necrosis region and the other four regions,but the difference in ADC was not statistically significant（P0.05） among the cartilaginous tumor survival region,tumor post-necrosis collagen,cystic necrosis,hemocoele and secondary ABC region.Conclusion：ADC value may be affected by the living cartilaginous tumor elements in the judgement of osteosarcoma necrosis after neoadjuvant chemotherapy.ADC value can determine non-cartilaginous tumor living cells,necrotic cells and extra-cell interstitial tissue changes.