摘要
目的探讨ADC值对直肠癌术前放化疗疗效的早期监测的可行性及应用价值。方法搜集2004年12月到2006年10月26例经病理证实的原发性直肠癌患者，术前行常规MRI和DWI检查。测量放化疔过程中不同监测时间点（包括治疗前、治疗后第1周、治疗后第2周、手术前）肿瘤ADC值。以放化疗前肿瘤的临床T分期与术后病理T分期比较，以T分期是否降低为标准，分为治疗效果较好的T-降期组和治疗效果较差的T-未降期组。应用随机区组设计的方差分析比较肿瘤ADC值变化情况。结果26例中，T-降期组和T-未降期组分别为12和14例。T-降期组治疗前、治疗后第1周、治疗后第2周、手术前ADC值分别为（1．10±0．13）×10-3、（1．32±0．19）×10-3、（1．35±0．13）×10-3和（1．32±1．00）×10-3mm2／s，差异有统计学意义（F=16．420，P〈0．01）。T-未降期组在治疗后第1周ADC值由（1．16±0．16）×10-3mm2／s升高至（1．23±0．13）×10-3mm2／s，升高不明显（P〉0．05），在治疗后第2周ADC值继续升高至（1．30±0．16）×10-3mm2／s，差异有统计学意义（F=5．023，P〈0．01）。用治疗后第1周肿瘤平均ADC值升高程度11．6％作为诊断直肠癌T分期是否出现降期的指标，诊断敏感性为75．0％，特异性为78．6％，阳性预测值为75．0％，阴性预测值为78．6％。ROC曲线下面积为0．774（95％可信区间为0．583～0．964），具有中等诊断价值。结论ADC值具有作为早期监测直肠癌放化疗疗效影像学指标的可能性。治疗第1周肿瘤平均ADC值变化对于区分放化疗反应性较为敏感，可以作为有效的时间监测点。
Objective To assess response of rectal carcinoma to preoperative chemoradiation therapy （CRT） using DWI and tumor ADC values, and to investigate the value of ADC in predicting and monitoring therapeutic effect of CRT. Methods Twenty-six patients with primary rectal carcinoma undergoing preoperative CRT were recruited to the study. DWI was performed on a 1.5 T MR scanner in all patients at the time point of pre-therapy, the end of the 1st, 2nd week of therapy and pre-operation, respectively. ADC values of the tumors were calculated on the workstation. Randomized block design was applied to analyze change in ADCs following treatment. Results All patients were divided into T-downstaging group （ n = 12 ） and T-non-downstuging group （n = 14）. In T-downstaging group, the mean tumor ADC values were （ 1.10 ± 0. 13） × 10-3, （ 1.32 ±0. 19） × 10-3, （ 1.35 ± 0. 13 ） × 10-3, （ 1.32 ± 1.00） × 10-3 mm2/s at the time point of pretreatment, week 1, week 2, pre-operation, respectively（ F = 16. 420, P 〈 0. 01 ）. The mean tumor ADC value in T-non-downstaging had a slight increase from （1.16 ± 0. 16 ） × 10-3 mm2/s to （1.23 ± 0. 13 ） × 10-3 mm2/s at the time of week 1 （P 〉 0.05 ）. The ADC value in T-non-downstaging group continuously increased to （ 1.30 ± 0. 16） × 10 -3 mm2/s at the end of the 2nd week of CRT（ F = 5. 023, P 〈0. 01 ） and appeared statistical difference. The evolution of tumor ADC values in the two groups was significantly different. Early increases in tumor ADC were observed in T-downstaging group. Regarding the increase percentage of ADC value at 1 st week as a diagnostic marker of tumor downstaging, when it was set as 11.6%, the sensitivity, specificity, positive predictive value and negative predictive value is 75. 0%, 78.6% ,75.0% and 78.6% respectively, the area under curve （Az） was 0. 774 （95% confidence interval： 0. 583 to 0. 964）. Conclusions An early significant increase of mean tumor ADC value in rectal carcinoma has a potential
出处
《中华放射学杂志》
CAS
CSCD
北大核心
2010年第4期392-396,共5页
Chinese Journal of Radiology
基金
基金项目：国家“973”重点基础研究发展计划资助项目（2006CB705706）
首都医学发展科研基金资助项目（2007-3081）
北京市自然科学基金资助项目（7072018）
关键词
直肠肿瘤
磁共振成像
治疗结果
Rectal neoplasms
Magnetic resonance imaging
Treatment outcome
