本文關鍵詞：磁共振DWI在肺癌腦轉移瘤放化療聯(lián)合中藥治療早期療效評價的應用研究　出處：《北京中醫(yī)藥大學》2017年碩士論文　論文類型：學位論文

  更多相關文章： 擴散加權成像 腦轉移瘤 表觀擴散系數 療效評估

【摘要】：目的:通過觀察肺癌腦轉移瘤在放化療聯(lián)合中藥治療前、后ADC值的變化,分析病灶治療有效組與無效組的早期ADC值變化規(guī)律,探討磁共振擴散加權成像(DWI)作為一種早期、無創(chuàng)、可重復的功能學成像方法,通過對治療早期ADC值檢測,來評價肺癌腦轉移瘤放化療聯(lián)合中藥治療療效的早期應用價值。方法:收集30例經病理或臨床及影像學確診為肺癌腦轉移瘤病人,分別對患者放化療聯(lián)合中藥治療前1周,治療1周期,治療2周期后進行T1WI平掃、T2WI平掃、T1WI增強MRI和磁共振擴散加權成像(DWI)檢查,通過在常規(guī)及T1WI增強MRI圖像上選擇病灶最大層面并測量其最大徑,對比治療前和治療后2周期腫塊體積變化,依照實體瘤的療效評價標準(RECIST),將其分為有效組與無效組。然后把DWI圖像(b=0,1000s/mm2)傳送到飛利浦工作站生成ADC圖,測量出ADC值,對治療前有效組與無效組ADC值進行對比,統(tǒng)計學方法采用獨立樣本t檢驗,了解治療前病灶ADC值大小是否對于肺癌腦轉移瘤治療療效有預測作用。通過公式計算有效組與無效組治療1周期的ADC變化率:△ADC%=(ADC后-ADC前)/ADC前×100%,對治療后1周期有效組與無效組△ADC%運用獨立樣本t檢驗方法對比分析,了解其是否具有統(tǒng)計學意義。此外,根據不同組別的△ADC%的數據,運用受試者工作特征(ROC)曲線評價治療1周期△ADC%診斷效能,得到△ADC%最佳閾值。所有數據采用SPSS20.0軟件分析。結果:30例患者共計43個肺癌腦轉移病灶,治療前病灶最大直徑為(2.78±0.15)cm,治療1周期后病灶最大直徑為(2.69±0.14)cm,病灶治療前與治療1周期最大直徑比較,差異無統(tǒng)計學意義(t=1.725,P=0.092),提示肺癌轉移瘤病灶在綜合治療早期體積變化無統(tǒng)計學差異。在治療后2周期后,病灶最大直徑為(2.24±0.13)cm,與治療前病灶最大直徑為(2.78±0.15)cm比較,差異有統(tǒng)計學意義(t=1.420,P=0.000),有效22例(有效組),無效21例(無效組),提示病灶在治療后2個周期后體積變化有統(tǒng)計學差異。肺癌腦轉移瘤治療前一周內有效組的平均ADC值(0.97±0.05)×10-3mm2/s,而無效組平均ADC值為(1.17±0.06)×10-3mm2/s,有效組與無效組之間無統(tǒng)計學差異(t=2.42,p=0.083),說明治療前病灶ADC值不能有效預測治療反應。有效組治療前1周期平均ADC值(0.97±0.05)×10-3mm2/s,治療1周期后平均ADC值(1.21±0.04)×10-10-3mm2/s,兩者差異有統(tǒng)計學意義(t=-8.76,p=0.000)。說明有效組在治療1周期后ADC值明顯增高。而治療無效組治療前1周期平均ADC值(1.17±0.07)×10-3mm2/s,治療后1周期后平均ADC值(1.20±0.08)×10-3mm2/s,兩者差異無統(tǒng)計學意義(t=-0.98,p=0.33),說明無效組在治療1周期后病灶ADC可能增大或者減小。根據公式計算出△ADC%=(ADC后-ADC前)/ADC前×100%,有效組ADC值變化率增加比較明顯,△ADC(%)=(28.23±3.97)%,而無效組ADC值變化率有輕度的增加或部分病灶△ADC值減少,△ADC(%)=(2.5±2.27)%。運用獨立樣本t檢驗統(tǒng)計學方法,所得治療1周期后在有效組與無效組之間ADC值變化率存在統(tǒng)計學差異(t=5.537,p=0.029),即治療后1周期有效組ADC值變化率高于無效組。然后運用受試者工作特征(ROC)曲線評估治療1周期ADC值變化率診斷效能,以治療1周期ADC值升高以12.9%為閾值時,檢測肺癌腦轉移治療敏感性為81,8%,特異性為85.7%,ROC曲線下面積(AUC)為0.898,95%的可信區(qū)間0.805～0.992,提示有較高的診斷效能,具有較高的可信度。結論:1.磁共振擴散加權成像技術(DWI-MRI)可作為一種早期、無創(chuàng)、可重復的功能學成像方法,能夠反映腫瘤治療早期的微觀病理改變,可以早期預測肺癌腦轉移瘤放化療聯(lián)合中藥治療的療效。2.肺癌腦轉移瘤治療前1周ADC值的大小,暫不能作為預測放化療聯(lián)合中藥治療療效的一個指標。3.肺癌腦轉移瘤在放化療聯(lián)合中藥治療1周期后,ADC值變化率預測治療療效具有較高的診斷效能,以治療1周期ADC值變化率升高12.9%為閾值時,預測其治療有效的敏感性為81.8%,特異性為85.7%。
[Abstract]:Objective: through the observation of brain metastasis from lung cancer in chemotherapy combined with traditional Chinese medicine before treatment, after the change of ADC value, ADC analysis of early lesions treatment the effective group and the ineffective group value changes of diffusion weighted magnetic resonance imaging (DWI) as an early, noninvasive, repeatable functional imaging method based on the treatment of early ADC value detection, to evaluate the application value of early brain metastasis from lung cancer on the efficacy of chemotherapy combined with traditional Chinese medicine treatment. Methods: We collected 30 cases of pathological or clinical and imaging diagnosis of brain metastasis from lung cancer patients, respectively in patients with combined radiotherapy and chemotherapy in the treatment of 1 weeks before, 1 cycles of treatment, after 2 cycles of chemotherapy T1WI scan, T2WI scan, enhanced T1WI and MRI diffusion weighted magnetic resonance imaging (DWI) examination, through conventional and enhanced T1WI MRI images were chosen to measure the largest diameter and maximum level, compared to before the treatment and treatment after the 2 cycle of mass volume Change in accordance with the evaluation criteria in solid tumors (RECIST), which can be divided into the effective group and the ineffective group. Then DWI image (b=01000s/mm2) sent to the PHILPS workstation to generate ADC map, measure the ADC value of treatment before the effective group and the ineffective group ADC values were compared using statistical methods, independent samples t test. Understand the ADC value of lesions before treatment had the function to predict curative effect for brain metastasis from lung cancer treatment. The formula to calculate the effective group and ineffective group ADC change for 1 cycles: the rate of ADC%= (ADC -ADC ago) before /ADC * 100% to 1 weeks after the treatment period, the effective group and the ineffective group in contrast with the independent ADC% sample t test analysis, understand whether it has statistical significance. In addition, according to the ADC% of different groups of data, using the receiver operating characteristic (ROC) curve to evaluate the diagnostic efficacy of 1 treatment period DELTA ADC%, Delta ADC% get the best threshold. The number of all According to the analysis by SPSS20.0 software. Results: 30 cases of patients with a total of 43 lung cancer patients with brain metastases before treatment, lesions of maximum diameter (2.78 + 0.15) cm, after 1 cycles of chemotherapy were the largest diameter (2.69 + 0.14) cm lesions before treatment and after 1 cycles of treatment, the maximum diameter of comparison, the difference was not statistically significant (t=1.725, P=0.092), suggesting that lung cancer metastases were no significant difference in the volume change of early comprehensive treatment. After treatment after 2 cycles, the maximum diameter of lesions (2.24 + 0.13) cm, and the maximum diameter of lesions before treatment (2.78 + 0.15) cm comparison, the difference was statistically significant (t=1.420, P=0.000), 22 cases (effective group), 21 cases were invalid (invalid group), suggest that the lesions after treatment after 2 cycles. There were significant differences in tumor volume changes before treatment, the average ADC value of the group within a week of lung cancer with brain metastasis (0.97 + 0.05) * 10-3mm2 /s, and the invalid group average ADC value was (1.17 + 0.06 * 10-3mm) 2/s, there was no significant difference between the effective group and ineffective group (t=2.42, p=0.083), indicating that the treatment before the maximum ADC can not predict the response to treatment. Effective treatment before the 1 cycle the average value of ADC (0.97 + 0.05) * 10-3mm2/s, after 1 cycles of treatment. The average ADC value (1.21 + 0.04) * 10-10-3mm2/s, was statistically significant the difference between the two (t=-8.76, p=0.000). It is effective in treatment group after 1 cycles of ADC value was significantly higher. And the ineffective treatment group before treatment, 1 cycle average ADC value (1.17 + 0.07) * 10-3mm2/s, the average ADC value after 1 cycles after treatment (1.20 + 0.08) * 10-3mm2/ s, there were no significant difference between them (t=-0.98, p=0.33), that is invalid in treatment group after 1 cycles of ADC lesions may increase or decrease. The calculated according to the formula ADC%= (ADC -ADC ago) before /ADC * 100%, effective group variation rate of ADC increased obviously, ADC (%) = (28.23 + 3.97)%, and the invalid group ADC value the rate of change of a slight increase Or part of the lesions Delta ADC values decrease, ADC (%) = (2.5 + 2.27)%. Using independent sample t test statistical method, obtained after 1 cycles of chemotherapy in the effective group and ineffective group there was significant difference in the rate of change of the value of ADC (t=5.537, p=0.029), the value of 1 cycle change is higher than the effective group ADC invalid group after treatment. Then using the receiver operating characteristic (ROC) curve to evaluate the treatment of 1 cycle variation rate of ADC diagnostic efficiency in the treatment of 1 cycles of ADC increased to 12.9% as the threshold, the detection of brain metastases of lung cancer treatment sensitivity 81,8%, specificity of 85.7%, area under the ROC curve (AUC) for the confidence interval 0.898,95% 0.805 ~ 0.992, suggesting a higher diagnostic efficiency, has a higher reliability. Conclusion: 1. diffusion weighted magnetic resonance imaging (DWI-MRI) can be used as an early, noninvasive, repeatable functional imaging method, which can reflect the microscopic pathological change early tumor treatment Change can be predicted in 1 weeks before treatment ADC value of chemotherapy combined with traditional Chinese medicine treatment of lung cancer with brain metastasis effect.2. brain metastasis of lung cancer early, can not be used to predict the effect of chemotherapy combined with traditional Chinese medicine treatment on a.3. index of brain metastasis from lung cancer in chemotherapy combined with traditional Chinese medicine in the treatment of 1 weeks after the ADC value of diagnostic efficiency the prediction has high curative effect in the treatment of rate change, with 1 cycles of treatment ADC value change rate increased 12.9% as the threshold, to predict the effective therapeutic sensitivity was 81.8%, specificity was 85.7%.

【學位授予單位】：北京中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R445.2;R734.2

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