發(fā)布時間：2018-05-05 17:08

  本文選題：宮頸腫瘤 + 新輔助化療��； 參考：《昆明醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:探討動態(tài)對比增強(qiáng)磁共振(dynamic contrast-enhanced MRI,DCE-MRI)定量參數(shù)(Ktrans,Kep,Ve,Vp)聯(lián)合擴(kuò)散加權(quán)成像(diffusion weighted imaging,DWI)的表觀擴(kuò)散系數(shù)(apparent diffusion coefficient,ADC)對宮頸癌新輔助化療(neoadjuvant chemotherapy,NACT)療效評估的價值。材料與方法:收集38例經(jīng)病理證實(shí)的據(jù)國際婦產(chǎn)科聯(lián)盟(International Federation of GynecologyandObstetrics,FIGO)分期均為巨塊型 IB2-IIA 期(長徑(?)4cm)和IIB期宮頸癌患者資料,所有患者均在治療前、NACT一個療程結(jié)束一個月后分別行常規(guī)磁共振掃描、DCE-MRI及DWI掃描。治療后根據(jù)實(shí)體腫瘤療效評價標(biāo)準(zhǔn)(Response Evaluation Criteria in Solid Tumors,RECIST)將治療療效分為兩組:反應(yīng)組和非反應(yīng)組,其中反應(yīng)組(significant reaction group,sCR)包含CR完全緩解(Complete Response, CR)和 PR 部分緩解(Partial Response, PR),非反應(yīng)組(non-significant reaction group, non-sCR)包含 SD 疾病穩(wěn)定(Stable Disease, SD)和PD疾病進(jìn)展(Progressive Disease, PD)。測量并比較各組治療前后DCE-MRI定量參數(shù)(Krans_,Kep,Ve,Vp)和ADC值(平均ADC值、最小ADC值)及相應(yīng)參數(shù)變化值(△治療=治療后參數(shù)—治療前參數(shù))有無差異,采用ROC (receiver operating characteristic curve)分析分析各參數(shù)對治療反應(yīng)性評估的效能,并獲得sCR組與non-sCR組的療效預(yù)測及評估的臨界點(diǎn)。結(jié)果:38例患者平均年齡為44.79±8.17歲,其中ⅠB2期患者14例;ⅡA期1例;ⅡB期23例。治療后,sCR組患者22例,non-sCR組16例。治療前sCR組的Ktrans,Kep,Ve,Vp、平均 ADC 及最小 ADC 均值分別為:0.875±0.329min-1、1.612+0.733min-1、0.661 ±0.184min-1、0.283±0.208 min-1、971.612±140.209mm2/s、640.943 ±200.697mm2/s; non-sCR 為:0.549±0.314min-1、1.557±0.680min-1、0.791± 0.117 min-1、0.205 ± 0.123 min-1、918.779 ± 140.991 mm2/s、548.619 ±213.220mm2/s; sCRKtrans高于non-sCR組,Ve低于non-sCR組,差異有統(tǒng)計學(xué)意義(z=-3.134, p0. 05; z=-2.129, p0. 05)。治療后,sCR 組的 Ktrans, Kep,Ve,Vp平均 ADC 及最小 ADC 均值分別為:0.553±0.347min-1、1.523±0.849min-1、0.746±0.221 min-1、0.201 ±0.194min-1、1048.238±139.899mm2/s、710.916± 155.863 mm2/s;non-sCR 組為:0.942±0.508 min-1、1.960±0.990 min-1、0.758±0.177 min-1、0.203±0.151min-1、947.050±153.514mm2/s、545.458±163.015mm2/s; sCR組Ktrans及△Ktrans_ (△Ktrans=-0.322±0.261min-1)低于 non-sCR 組,平均 ADC 值、最小ADC值高于non-sCR組,差異有統(tǒng)計學(xué)意義(z=-2.602,p0. 05; t=-6.074,p0. 05 ; z=-2.099, p0.05;t=3.170,p0.05)。其余各參數(shù)無統(tǒng)計學(xué)差異。治療前Ktrabs、治療前Ktrans聯(lián)合治療后平均ADC值用于預(yù)測化療療效效果的曲線下面積(AUC)分別為 0.801 (p0. 05)、0.878 (p0. 05),治療前 Ktrans的診斷閾值為0.7020 (敏感度為77.3%,特異度為81.22%)。結(jié)論:1、DCE-MRI定量參數(shù)及DWI的ADC值能夠反映宮頸癌NACT前后的血流動力學(xué)及水分子擴(kuò)散運(yùn)動變化情況,是一種能從微觀上評估腫瘤療效的新途徑和方法,有望成為早期評價宮頸癌治療療效的影像學(xué)方法。2、定量DCE-MRI聯(lián)合DWI并不比兩種技術(shù)單獨(dú)應(yīng)用能顯著提高NACT療效的診斷效能。
[Abstract]:Objective: to evaluate the value of dynamic contrast-enhanced MRII-DCE-MRI quantitative parameters and diffusion weighted diffusion imaging (DWI) in evaluating the efficacy of neoadjuvant chemotherapy in neoadjuvant chemotherapy of cervical cancer (neoadjuvant NACTs) by dynamic contrast enhanced Mr imaging (DCE-MRI) and diffusion weighted imaging (DWI). Materials and methods: data of 38 pathologically confirmed cervical cancer patients with large IB2-IIA stage (long diameter 4 cm) and IIB stage according to International Federation of Gynecology and Obstetrics Figo were collected. All patients underwent conventional magnetic resonance imaging (DCE-MRI) and DWI scan one month after the end of a course of treatment. After treatment, the patients were divided into two groups according to response Evaluation Criteria in Solid tumor RECIST: reactive group and non-reactive group. The response group included complete CR complete response (CRs) and PR partial response (PRP), non-significant reaction group (non-sCRs) including SD stable disease release (SDS) and PD progressive disease progression (PDS), which included CR complete response (CR) and PR partial response (PRP), non-significant reaction group (non-sCRs), including SD (SD) and PD progressive disease progression (PDS), which included complete response (CR), partial response (PR), non-significant reaction group (non-sCRs), and progressive disease progression (PD). The quantitative parameters of DCE-MRI were measured and compared before and after treatment. There were no differences in ADC, ADC (mean ADC value, minimum ADC value) and the corresponding parameters before and after treatment (treatment = post-treatment parameters-pre-treatment parameters). ROC receiver operating characteristic curve was used to analyze the efficacy of each parameter in evaluating the response to treatment, and the critical points for predicting and evaluating the efficacy of sCR group and non-sCR group were obtained. Results the average age of 38 cases was 44.79 鹵8.17 years old, including 14 cases of stage 鈪，

本文編號：1848561