磁共振彌散加權(quán)成像技術(shù)預(yù)測鼻咽癌放射敏感性的價值及其機(jī)制研究
發(fā)布時間：2019-01-21 10:09
【摘要】：背景與目的鼻咽癌的療效與放射敏感性密切相關(guān)，但目前缺乏預(yù)測其放射敏感性的有效方法。磁共振彌散加權(quán)成像（MR-DWI）技術(shù)具有分子功能影像的特點(diǎn)，且能提供定量參數(shù)表觀彌散系數(shù)（ADC），它與宮頸癌、肝癌、頭頸部癌的放化療反應(yīng)性有一定的相關(guān)性。本研究擬從動物模型和患者兩個層面探討MR-DWI技術(shù)預(yù)測鼻咽癌放射敏感性的價值及其作用機(jī)制，為其應(yīng)用于臨床提供依據(jù)。材料與方法①將荷人鼻咽癌裸鼠隨機(jī)分成對照組和照射組（單次照射劑量15Gy）。分別測量照射前的ADC值（ADC0）和照射后第二天的ADC值（ADC1），ΔADC=(ADC1-ADC0)/ADC0*100%。照射后第X天移植瘤的體積變化ΔVx=（Vx-V0）/VO*100%；第X天對照組與照射組體積變化的差值定義為輻射相關(guān)體積變化δVX=ΔVxc-ΔVxt。②以SPECT進(jìn)行鼻咽癌裸鼠移植瘤99mTc-HL91乏氧顯像，分析腫瘤組織與正常組織的放射性計數(shù)比值（T/NT）與ADC值的相關(guān)性。③另外將荷瘤裸鼠隨機(jī)分為未照射組、照射后第1、2、3、5和7天組，比較移植瘤的ADC值和HIF-1α表達(dá)動態(tài)變化的相關(guān)性。④收集2010年4月至2011年11月間本單位鼻咽癌患者，采用調(diào)強(qiáng)放療±化療。分別測量治療前鼻咽原發(fā)灶的ADC值（ADC0）和放療兩周時ADC值（ADC1），△ADC=（ADC1-ADC0）/ADC0*100%。放療結(jié)束后3個月按WHO實(shí)體瘤療效評價標(biāo)準(zhǔn)評價近期療效。結(jié)果①CNE1組和CNE2組間移植瘤ADC0無顯著差異，ADC1及△ADC差異有統(tǒng)計學(xué)意義�！鰽DC與δVX從照射后第2天開始即存在負(fù)相關(guān)關(guān)系，多元線性回歸分析發(fā)現(xiàn)ΔADC是照射后第14天δVx的獨(dú)立影響因素。②移植瘤的ADC值和HL-91乏氧顯像后4h移植瘤與對側(cè)正常組織放射性計數(shù)比值成負(fù)相關(guān)關(guān)系。③移植瘤照射后ADC值的變化與HIF-1α的蛋白和mRNA表達(dá)水平呈明顯負(fù)相關(guān)。④共有134例鼻咽癌患者符合條件，其中合并化療121例。放療后三個月時鼻咽局部有殘留者23例（17.2%），無殘留患者111例（82.8%），，兩組的△ADC分別為49.77%±31.02%和68.35%±34.22%，差別有統(tǒng)計學(xué)意義（t=-2.406，P=0.017）。Logistic回歸分析結(jié)果表明△ADC是鼻咽癌調(diào)強(qiáng)放療近期療效的獨(dú)立預(yù)后因素。結(jié)論 MR-DWI技術(shù)具有應(yīng)用于預(yù)測鼻咽癌放射敏感性的潛在能力，作用機(jī)制可能與乏氧有關(guān)。
[Abstract]:Background and objective the efficacy of nasopharyngeal carcinoma is closely related to its radiosensitivity, but there is no effective method to predict its radiosensitivity. Magnetic Resonance Diffusion-weighted Imaging (MR-DWI) has the characteristics of molecular functional imaging and can provide quantitative parameter apparent diffusion coefficient (ADC),) which is related to the radiochemotherapeutic reactivity of cervical carcinoma liver cancer and head and neck cancer. The purpose of this study was to explore the value and mechanism of MR-DWI in predicting radiosensitivity of nasopharyngeal carcinoma (NPC) from animal model and patient level, and to provide evidence for its clinical application. Materials and methods 1 Nude mice bearing human nasopharyngeal carcinoma were randomly divided into control group and irradiation group (single dose of 15Gy). ADC value (ADC0) before irradiation and ADC value (ADC1), 螖 ADC= (ADC1-ADC0) / ADC0*100%. on the second day after irradiation were measured, respectively. Volume change of transplanted tumor 螖 Vx= (Vx-V0) / VO*100%; on day X after irradiation On day X, the difference of volume changes between the control group and the irradiation group was defined as radiation-related volume change 未 VX= 螖 Vxc- 螖 Vxt.2 using SPECT to perform 99mTc-HL91 hypoxia imaging of transplanted tumor of nasopharyngeal carcinoma in nude mice. The correlation between the radioactivity count ratio (T/NT) of tumor tissue to normal tissue and the ADC value was analyzed. 3 in addition, the nude mice were randomly divided into two groups: the non-irradiated group, the 5th and 7th day groups after irradiation. To compare the correlation between ADC value and HIF-1 偽 expression in transplanted tumor. 4 patients with nasopharyngeal carcinoma were collected from April 2010 to November 2011 and received intensity modulated radiotherapy + chemotherapy. ADC value (ADC0) and ADC value (ADC1), ADC= (ADC1-ADC0) / ADC0*100%. of nasopharyngeal primary focus were measured before treatment and two weeks after radiotherapy, respectively. Three months after radiotherapy, the short-term efficacy was evaluated according to the criteria for evaluating the efficacy of WHO solid tumor. Results there was no significant difference in ADC0 between 1CNE1 group and CNE2 group, but there was significant difference in ADC1 and ADC. There was a negative correlation between ADC and 未 VX from the second day after irradiation. Multiple linear regression analysis showed that 螖 ADC was the independent factor of 未 Vx on the 14th day after irradiation. (2) there was a negative correlation between the ADC value of transplanted tumor and the radioactivity count ratio of contralateral normal tissue at 4h after HL-91 hypoxia imaging. The change of ADC value after irradiation was negatively correlated with the expression of HIF-1 偽 protein and mRNA. 4 A total of 134 patients with nasopharyngeal carcinoma were eligible. Among them 121 cases were complicated with chemotherapy. Three months after radiotherapy, there were 23 cases (17.2%) with residual nasopharynx and 111 cases (82.8%) with no residual nasopharynx. The ADC of the two groups was 49.77% 鹵31.02% and 68.35% 鹵34.22%, respectively. The difference was statistically significant (twe-2.406). Logistic regression analysis showed that ADC was an independent prognostic factor for the short-term therapeutic effect of intensity-modulated radiotherapy for nasopharyngeal carcinoma (NPC). Conclusion MR-DWI has the potential to predict radiosensitivity of nasopharyngeal carcinoma, and the mechanism may be related to hypoxia.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2012
【分類號】：R445.2;R739.63
本文編號：2412551
[Abstract]:Background and objective the efficacy of nasopharyngeal carcinoma is closely related to its radiosensitivity, but there is no effective method to predict its radiosensitivity. Magnetic Resonance Diffusion-weighted Imaging (MR-DWI) has the characteristics of molecular functional imaging and can provide quantitative parameter apparent diffusion coefficient (ADC),) which is related to the radiochemotherapeutic reactivity of cervical carcinoma liver cancer and head and neck cancer. The purpose of this study was to explore the value and mechanism of MR-DWI in predicting radiosensitivity of nasopharyngeal carcinoma (NPC) from animal model and patient level, and to provide evidence for its clinical application. Materials and methods 1 Nude mice bearing human nasopharyngeal carcinoma were randomly divided into control group and irradiation group (single dose of 15Gy). ADC value (ADC0) before irradiation and ADC value (ADC1), 螖 ADC= (ADC1-ADC0) / ADC0*100%. on the second day after irradiation were measured, respectively. Volume change of transplanted tumor 螖 Vx= (Vx-V0) / VO*100%; on day X after irradiation On day X, the difference of volume changes between the control group and the irradiation group was defined as radiation-related volume change 未 VX= 螖 Vxc- 螖 Vxt.2 using SPECT to perform 99mTc-HL91 hypoxia imaging of transplanted tumor of nasopharyngeal carcinoma in nude mice. The correlation between the radioactivity count ratio (T/NT) of tumor tissue to normal tissue and the ADC value was analyzed. 3 in addition, the nude mice were randomly divided into two groups: the non-irradiated group, the 5th and 7th day groups after irradiation. To compare the correlation between ADC value and HIF-1 偽 expression in transplanted tumor. 4 patients with nasopharyngeal carcinoma were collected from April 2010 to November 2011 and received intensity modulated radiotherapy + chemotherapy. ADC value (ADC0) and ADC value (ADC1), ADC= (ADC1-ADC0) / ADC0*100%. of nasopharyngeal primary focus were measured before treatment and two weeks after radiotherapy, respectively. Three months after radiotherapy, the short-term efficacy was evaluated according to the criteria for evaluating the efficacy of WHO solid tumor. Results there was no significant difference in ADC0 between 1CNE1 group and CNE2 group, but there was significant difference in ADC1 and ADC. There was a negative correlation between ADC and 未 VX from the second day after irradiation. Multiple linear regression analysis showed that 螖 ADC was the independent factor of 未 Vx on the 14th day after irradiation. (2) there was a negative correlation between the ADC value of transplanted tumor and the radioactivity count ratio of contralateral normal tissue at 4h after HL-91 hypoxia imaging. The change of ADC value after irradiation was negatively correlated with the expression of HIF-1 偽 protein and mRNA. 4 A total of 134 patients with nasopharyngeal carcinoma were eligible. Among them 121 cases were complicated with chemotherapy. Three months after radiotherapy, there were 23 cases (17.2%) with residual nasopharynx and 111 cases (82.8%) with no residual nasopharynx. The ADC of the two groups was 49.77% 鹵31.02% and 68.35% 鹵34.22%, respectively. The difference was statistically significant (twe-2.406). Logistic regression analysis showed that ADC was an independent prognostic factor for the short-term therapeutic effect of intensity-modulated radiotherapy for nasopharyngeal carcinoma (NPC). Conclusion MR-DWI has the potential to predict radiosensitivity of nasopharyngeal carcinoma, and the mechanism may be related to hypoxia.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2012
【分類號】：R445.2;R739.63
【參考文獻(xiàn)】
相關(guān)期刊論文 前2條
1 李洪杰;邊杰;沙琳;孫闖;孫傳恕;劉書峰;翟方兵;;新生豬缺氧缺血性腦損傷早期DWI影像學(xué)研究[J];大連醫(yī)科大學(xué)學(xué)報;2011年05期
2 聶翔;李金高;;鼻咽癌磁共振彌散加權(quán)成像與放療療效的相關(guān)性研究[J];實(shí)用癌癥雜志;2011年06期
本文編號：2412551
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