3.0T MRDWI预测鼻咽癌放化疗敏感性的研究

2016-08-23于红梅翟昭华顾明马代远刘

国际医学放射学杂志 2016年1期

关键词：疗效

于红梅翟昭华顾　明马代远刘　念

论著

3.0T MRDWI预测鼻咽癌放化疗敏感性的研究

于红梅1翟昭华2顾明1马代远3刘念2

目的探讨 3.0 T MR扩散加权成像（DWI）在评估鼻咽癌（NPC）放化疗（CRT）疗效中的价值，预测NPC对CRT的敏感性。方法收集32例经病理证实的NPC病人，行常规MRI及DWI检查，测量CRT前与CRT 5周时NPC及转移性淋巴结最大者的体积和ADC值。以CRT后1个月病理活检和MRI检查作为疗效评价标准将NPC分为低敏感与高敏感组，比较CRT 5周时NPC低敏感组与高敏感组ADC值、治疗前后ADC值变化率（ΔADC）及体积消退率（ΔV）的差异；分析影响NPC CRT敏感性的相关因素。结果CRT 5周时NPC ADC值、ΔADC及ΔV在高、低敏感组之间差异均有统计学意义（P＜0.05），ΔADC为鉴别低敏感与高敏感组最佳指标，其截断值为98.125%，敏感度为95.5%，特异度为90%。非线性Logistic回归分析影响NPC CRT敏感性的相关因素（性别、年龄、治疗方式、T分期及ΔADC），结果显示ΔADC是影响NPC CRT敏感程度的独立预后因素，其相对风险度为1.155。结论DWI对于评价NPC CRT疗效有重要作用。CRT 5周时NPC ADC值、ΔADC及ΔV都能有效预测NPC CRT敏感性，ΔADC是预测NPC CRT敏感性的最佳指标及独立预后因素。

鼻咽癌；扩散加权成像；表观扩散系数；放化疗；敏感性

【Abstract】ObjebtiveTo investigate the value of diffusion-weighted 3.0 T MR imaging（DW-MRI）for evaluating therapeutic effect of chemoradiotherapy（CRT）and predicting sensitivity of CRT in nasopharyngeal carcinoma（NPC）.

MethodsThirty-two cases with NPC confirmed by pathological biopsy underwent conventional MRI and DWI.We measured the apparent diffusion coefficient（ADC）values before and 5 weeks after CRT.At the same time，the volume of NPC primary tumors and metastatic lymph nodes were measured.Thirty-two cases were grouped into hypersensitivity and hyposensitivity groups based on pathologicaly and MRI findings after a month of therapy.The ADC values，change rate of ADC values（ΔADC），and volume of faded rate（ΔV）during the 5 weeks were compared between the hypersensitivity and hyposensitivity groups.Logistic regression analysis was used to determine sensitive factors for in NPC chemoradiotherapy.

ResultsThe ADC，ΔADC and ΔV value of NPC were statistically difference between hypersensitivity and hyposensitivity groups（P＜0.05）at 5 weeks afer CRT.The ΔADC was the best measure to discriminate the two groups（cutoff 98.125%，sensitivity，95.5%，specificity，90%）.Nonlinear Logistic regression analysis including sex，age，treatment，T stage，and ΔADC showed that ΔADC was dependent variable for effecting CRT sensitivity of NPC（relative risk，1.155）.ConclusionDWI has an important role in evaluating therapeutic effect of CRT in NPC.The ADC value，ΔADC，and ΔV of NPC at 5 weeks after CRT could predict the CRT sensitivity.The ΔADC is the best indicator in predicting CRT sensitivity，and is a dependent variable for effecting CRT sensitivity in NPC.

鼻咽位于头颈联合区深部，解剖结构复杂，邻近重要器官和颅内神经，鼻咽部肿瘤外科手术风险较高。目前，以放疗为主的综合治疗是鼻咽癌（nasopharyngeal carcinoma，NPC）的主要治疗方法，采用MR