摘要
目的探讨磁共振纹理分析技术在预测直肠癌新辅助放化疗疗效的应用价值。方法前瞻性纳入34例于2015年2月至2017年4月期间在浙江省人民医院住院治疗的直肠癌患者，于新辅助治疗前（治疗前1天）、早期（治疗开始后第10天）及中期（治疗开始后第20天）分别行3．0T磁共振（MRI）检查。病例纳入标准：直肠镜检查肿瘤下缘距肛缘12cm以内，术前病理活检确诊且临床分期为T3及以上或有淋巴结转移但无远处转移的直肠癌，并且肝肾心肺功能正常无手术禁忌证。病例剔除标准：未完成新辅助放化疗、手术及3次磁共振检查，或图像运动伪影和缺失术后病理学结果。所有患者均选择直肠癌长程三维放化疗同时合并化疗（奥沙利铂加卡培他滨）的新辅助治疗。根据放化疗后肿瘤消退分级（TRG）分为TRG 0～4级，达到TRG4归为病理完全缓解（pCR）；TRG 2～3级归于部分缓解（PR），其余为未缓解（NR）。应用OmniKinetics软件提取2次磁共振T2加权图像上肿瘤区域的纹理特征（方差、熵、能量、峰度），统计各时间点纹理值，分别比较各时间点pCR与PR加NR病例及NR与pCR加PR病例间纹理值及改变差值的差异，筛选出差异有统计学意义的纹理值，纳入受试者工作特性曲线（ROC）评估纹理值对新辅助放化疗疗效的预测效能。结果全组34例患者中，男性21例、女性13例；中位年龄49．3岁，其中低位直肠腺癌19例（55．9％），中位直肠腺癌15例（44．1％）。达到pCR为9例（26．5％），PR为13例（38．2％），NR为12例（35．3％）。新辅助放化疗前．pCR病例肿瘤区域的熵值水平明显高于PR加NR者（7．164±0．272比6．823±0．309，t=2．925，P=0．006）。在新辅助放化疗中期，与PR加NR病例肿瘤区域的纹理特征比较，pCR者的方差（1566±281比2883±867，t=-4．435，P=O．000）和熵值（5．436±0．934比6．80
Objective To explore the application value of texture analysis of magnetic resonance images （MRI） in predicting the efficacy of neoadjuvant chemoradiotherapy （nCRT） for rectal cancer. Methods A total of 34 rectal cancer patients who were hospitalized at Zhejiang Provincial People＇s Hospital from February 2015 to April 2017 were prospectively enrolled and received 3.0T MRI examination at pre-nCRT （1 day before nCRT）, early stage （at 10-day after nCRT） and middle stage （at 20-day after nCRT）. Inclusion criteria： distance from tumor lower margin to anal edge was less than 12 cm under rectoscope; rectal cancer was confirmed by preoperative pathology; clinical stage was T3 or above; lymph node metastasis existed but without distant metastasis; functions of liver, kidney and heart present no contraindications of operation. Exclusion criteria： unfinished nCRT, surgery and three examinations of MRI; image motion artifacts; lack of postoperative pathological results. All the patients underwent rectal cancer long-term three-dimensional radiotherapy and chemotherapy combined with nCRT （oxaliplatin plus capecitabine）. The tumor regression grading （TRG） was divided into TRG 0 to 4 grade after nCRT, and TRG 4 was classified as pathological complete remission （pCR）; TRG 2 to 3 was classified as partial remission （PR） ; the rest was no remission （NR）. Extraction and analysis of texture features in T2-weighted MR-defined tumor region were performed using Omni Kinetics texture software. The texture values of each time point were statistically analyzed, and the differences of texture values and change differences between pCR and PR ＋NR, and NR and pCR ＋PR were compared respectively. Statistically significant texture values were screened and were used in receiver operating characteristic （ROC） curve to assess the prediction of the efficacy of nCRT. Results Of 34 patients, 21 were males and 13 were females with median age of 49.3 years. Nineteen （55.9%） patients were low recta
作者
舒震宇
方松华
丁忠祥
毛德旺
庞佩佩
龚向阳
Shu Zhenyu;Fang Songhua;Ding Zhongxiang;Mao Dewang;Pang Peipei;Gong Xiangyang(Department of Radiology,Zhejiang Province People＇s Ho,spital,Hangzhou310014,China)
出处
《中华胃肠外科杂志》
CAS
CSCD
北大核心
2018年第9期1051-1058,共8页
Chinese Journal of Gastrointestinal Surgery
基金
浙江省卫计委科研基金项目（2017174851）
关键词
直肠肿瘤
磁共振成像
纹理分析
新辅助放化疗
Rectal neoplasms
Magnetic resonance imaging
Texture analysis
Neoadjuvant chemoradiotherapy
