中国癌症杂志 ›› 2018, Vol. 28 ›› Issue (5): 369-375.doi: 10.19401/j.cnki.1007-3639.2018.05.008

• 论著 • 上一篇    下一篇

磁共振扩散峰度成像预测鼻咽癌放疗近期疗效研究

吴 刚1,王 奋1,林少民1,张 帅1,黄小鹏1,黄薇园2   

  1. 1. 海南省人民医院放疗科,海南 海口 570311 ;
    2. 海南省人民医院放射科,海南 海口 570311
  • 出版日期:2018-05-30 发布日期:2018-06-12
  • 通信作者: 黄薇园 E-mail: huangwy45@qq.com
  • 基金资助:
    海南省自然科学基金面上项目(20168275);吴阶平基金(320.6750.17130)。

The value of diffusion kurtosis imaging to predict early radiotherapy response in nasopharyngeal carcinoma patients

WU Gang1, WANG Fen1, LIN Shaomin1, ZHANG Shuai1, HUANG Xiaopeng1, HUANG Weiyuan2   

  1. 1. Department of Radiation Oncology, Hainan General Hospital, Haikou 570311, Hainan Province, China. 2. Department of Radiology, Hainan General Hospital, Haikou 570311, Hainan Province, China
  • Published:2018-05-30 Online:2018-06-12
  • Contact: HUANG Weiyuan E-mail: huangwy45@qq.com

摘要: 背景与目的:磁共振(magnetic resonance imaging,MRI)扩散峰度成像(diffusion kurtosis imaging,DKI)是非侵入性新型功能成像技术,是扩散张量成像(diffusion tensor imaging,DTI)技术的延伸和发展,该研究运用MRI-DKI技术的相关参数前瞻性分析该技术在预测鼻咽癌放疗近期疗效中的作用。方法:收集2014年11月—2017年8月在海南省人民医院就诊的60例鼻咽癌患者,所有患者在治疗前、后分别行MRI扫描及DKI扫描,治疗后3个月的MRI检查按RECIST 1.1标准评估疗效,分为治疗反应组(response group,RG)和无反应组(no-response group,NRG)。结果:治疗前肿瘤最大层面直径在两组间差异无统计学意义(P=0.057)。治疗前DKI扫描测得参数轴向扩散系数(axis diffusion coefficient,Dax)、平均扩散系数(mean diffusion coefficient,Dmean)和横向扩散系数(radius diffusion coefficient,Drad)在RG组明显高于NRG组(P=0.02、0.03和0.03),部分各向异性(fractional anisotropy,FA)、轴向峰度系数(axis kurtosis coefficient,Kax)、峰度部分各向异性(kurtosis fractional anisotropy,KFA)、平均峰度系数(mean kurtosis coefficient,Kmean)、横向峰度系数(radius kurtosis coefficient,Krad)和平均峰度张量(mean kurtosis tensor,Mkt)在RG组明显低于NRG组(P=0.03、0.02、0.01、0.00、0.00和0.00)。Krad(临界值=0.76)是最好的预测放疗敏感性的参数。用受试者工作特征(receiver operating characteristic,ROC)曲线分析参数Krad显示,灵敏度为77.8%,特异度为93.7%[曲线下面积(area under curve,AUC)=0.913,95%CI:0.811~1.000]。多因素分析显示,DKI的参数是鼻咽癌放疗敏感性的独立预测因素。结论:MRI-DKI技术可用于预测鼻咽癌放疗的近期疗效。

关键词: 磁共振, DKI成像, 鼻咽癌, 放疗敏感性

Abstract: Background and purpose: Magnetic resonance imaging (MRI) diffusion kurtosis imaging (DKI) is a new non-invasive functional imaging technology, which is the extension and development of diffusion tensor imaging (DTI) technology. This study aimed to analyse MRI-DKI technology parameters to predict the early response to radiotherapy in nasopharyngeal carcinoma (NPC). Methods: Sixty cases of nasopharyngeal carcinoma treated in Hainan General Hospital from November 2014 to August 2017 were collected. All patients underwent conventional MRI and DKI before and after radiotherapy. Based on MRI and biopsy results 3 months after radiotherapy, these patients were divided into response group (RG) and no-response group (NRG). Results: The maximum diameters of tumors in RG and NRG patients were similar prior to radiotherapy (P=0.057). The pretreatment axis diffusion coefficient (Dax), mean diffusion coefficient (Dmean) and radius diffusion coefficient (Drad) were higher in RG than in NRG patients (P=0.02, 0.03 and 0.03). Conversely, the pretreatment fractional anisotropy (FA), axis kurtosis coefficient (Kax), kurtosis fractional anisotropy (KFA), mean kurtosis coefficient (Kmean), radius kurtosis coefficient (Krad) and mean kurtosis tensor (Mkt) were lower in RG than in NRG patients (P=0.03, 0.02, 0.01, 0.00, 0.00 and 0.00). The Krad coefficient (0.76) was the best parameter to predict the radiotherapy response. Based on receiver operating characteristic curve analysis, Krad showed 77.8% sensitivity and 93.7% specificity [area under curve (AUC)=0.913, 95%CI: 0.811-1.000]. Multivariate analysis indicated DKI parameters were independent prognostic factors for the short-term effect in NPC. Conclusion: MRI-DKI technology could be used to predict the early response to radiotherapy in NPC patients.

Key words: Magnetic resonance imaging (MRI), Diffusion kurtosis imaging (DKI), Nasopharyngeal carcinoma (NPC), Radiotherapy sensitivity