A pilot study of intravoxelincoherent motion sequence forprediction ofresponse to neoadjuvant chemoradiotherapy in locally advanced rectal cancer

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doi:10.19401/j.cnki.1007-3639.2017.12.012

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A pilot study of intravoxelincoherent motion sequence forprediction ofresponse to neoadjuvant chemoradiotherapy in locally advanced rectal cancer

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- A pilot study of intravoxelincoherent motion sequence forprediction ofresponse to neoadjuvant chemoradiotherapy in locally advanced rectal cancer
- China Oncology Vol. 27, Issue 12, Pages: 985-991(2017)
- 作者机构：
  
  复旦大学附属肿瘤医院放射诊断科，复旦大学上海医学院肿瘤学系,上海,200032
- 作者简介：
- 基金信息：
- DOI：10.19401/j.cnki.1007-3639.2017.12.012
  CLC：
- Published Online：11 January 2018，
  
  Published：11 January 2017
- 稿件说明：
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信超,孙轶群,毛健,等. 体素内不相干运动扩散加权成像在预测局部进展期直肠癌新辅助放化疗疗效中的初步研究[J]. 中国癌症杂志, 2017, 27(12): 985-991.

孙轶群. A pilot study of intravoxelincoherent motion sequence forprediction ofresponse to neoadjuvant chemoradiotherapy in locally advanced rectal cancer[J]. China Oncology, 2017, 27(12): 985-991.
信超,孙轶群,毛健,等. 体素内不相干运动扩散加权成像在预测局部进展期直肠癌新辅助放化疗疗效中的初步研究[J]. 中国癌症杂志, 2017, 27(12): 985-991. DOI： 10.19401/j.cnki.1007-3639.2017.12.012.

孙轶群. A pilot study of intravoxelincoherent motion sequence forprediction ofresponse to neoadjuvant chemoradiotherapy in locally advanced rectal cancer[J]. China Oncology, 2017, 27(12): 985-991. DOI： 10.19401/j.cnki.1007-3639.2017.12.012.

摘要

背景与目的：弥散加权成像(diffusion-weighted imaging，DWI)是目前检查活体组织中水分子扩散运动的理想方法，常规DWI使用单指数拟合函数得到表观扩散系数(apparent diffusion coefficient，ADC)值，而体素内不相干运动扩散加权磁共振成像(intravoxel incoherent motion MR imaging，IVIM-MRI)则采用足够多的低b值和高b值并使用双指数拟合函数，可获取更丰富的生物信息，因此本研究欲探讨IVIM-MRI的单、双指数模型在预测局部进展期直肠癌新辅助放化疗疗效中的应用价值。方法：纳入32例接受新辅助放化疗的局部进展期直肠癌并在新辅助治疗前、后行常规MR序列及IVIM序列扫描的患者。IVIM序列包括9个b值(0~800 s/ mm

)，所得IVIM序列原始数据经单、双指数模型处理，得到单、双指数模型衰减曲线，并生成对应参数图。测量新辅助治疗前、后肿瘤实质区单指数模型ADC值和双指数模型D值、灌注系数D

值、灌注分数f值，采用配对样本t检验进行分析；并比较病理完全缓解(pathological complete response，pCR)组和非pCR组新辅助治疗前、后参数差异。组间比较采用两独立样本t检验，P0.05为差异有统计学意义。结果：IVIM的单指数模型中，治疗前肿瘤平均ADC值［(133.2±21.5)×10

-5

mm/s］较治疗后［(166.9±29.7)×10

-5

mm/s］小且差异有统计学意义(P0.05)；双指数模型中，新辅助放化疗前pCR组肿瘤D*值［(4 471±1 271)×10

-5

mm/ s］低于非pCR组［(5 749±1 722)×10

-5

mm/s］，差异有统计学意义(P0.05)；新辅助放化疗后pCR组肿瘤D值［(97.0±14.6)×10

-5

mm/s］低于非pCR组［(113.4±22.6)×10

-5

mm/s］，且差异有统计学意义(P0.05)。结论：基于常规DWI序列，IVIM双指数模型可更加详细补充描述肿瘤扩散信息。

Abstract

Background and purpose: DWI is an ideal way to check the diffusion of water molecules in vivo. Apparent diffusion coefficient value derived from DWI based on a mono-exponential

model does not sufficiently demonstrate the characteristics of tissue behavior. Intravoxel incoherent motion (IVIM) can be used to estimate molecular diffusion and microcirculation in the capillaries separately through bi-exponential fitting of the DWI data using low and high b-value. This study aimed to determine the value of IVIM in predicting treatment response before preoperative chemoradiotherapy in locally advanced rectal cancer. Methods: A cohort of consecutive patients with histologically confirmed rectal adenocarcinoma treated with preoperative chemoradiotherapy followed by total mesorectal excision (TME) surgery was enrolled in a prospective pilot trial. All patients were examined using IVIM at two time points: 2 to 5 days before neoadjuvant chemoradiotherapy

1 to 4 days before surgery. The perfusion parameters (ADCstandard

f) were measured for tumor. The patients were classified into pathological complete response (pCR) group and non-pCR group according to the pathological results after operation. Those diffusion parameters were compared between before and after neoadjuvant chemoradiotherapy in all patients as well as in pCR and non-pCR groups with the t-test. Results: The final study population consisted of 32 patients. There were 11 patients with pCR and 21 patients with non-pCR. The mean tumor ADCstandard using the mono-exponential model for all patients was (133.2±21.5)×10

-5

mm/s before neoadjuvant chemoradiotherapy

(166.9±29.7)×10

-5

mm/ s after neoadjuvant chemoradiotherapy. The parameters showed significant difference between those two groups. By using the bi-exponential DWI in this study

we found that the mean tumor D

was (4 471±1 271)×10

-5

mm/s for pCR group

(5 749±1 722)×10

-5

mm/s for non-pCR group before neoadjuvant chemoradiotherapy. After neoadjuvant chemoradiotherapy

the mean tumor D was (97.0±14.6)×10

-5

mm/s for pCR group

(113.4±22.6)×10

-5

mm/ s for nonpCR group. All the parameters showe

d significant differences between those two groups (all P0.05). Conclusion: In locally advanced rectal cancer

IVIM of bi-exponential DWI can aid in describing diffusion information of tumor.

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复旦大学附属肿瘤医院大肠外科，复旦大学上海医学院肿瘤学系

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