Department of Radiology, Kanagawa Cancer Center, Yokohama, Japan.
NMR Biomed. 2010 May;23(4):347-52. doi: 10.1002/nbm.1467. Epub 2009 Nov 30.
The purpose of this study was to assess whether dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) can predict response to chemotherapy in advanced pancreatic cancer. DSC-MRI was performed using gradient-echo echo-planar imaging after bolus injection of contrast material. Fifty-four patients with advanced pancreatic cancer who were scheduled for chemotherapy were enrolled. ΔR2* was calculated using semi-automated computer analysis capable of tracking moving lesions during DSC-MRI. Pre-treatment maximum ΔR2* and clinical factors including gender, age, tumor stage (UICC III/IV), initial tumor size, and chemotherapy regimen were compared between patients with progressive disease and patients with stable disease as was determined at 3-month follow-up, and between patients with progressive disease and patients with stable disease as was determined at 6-month follow-up. Receiver operating characteristic (ROC) analysis and the Kaplan-Meier method with log-rank test were used to assess the relationship between the pre-treatment maximum ΔR2* and early progression (i.e. at 3-month follow-up). The pre-treatment maximum ΔR2* of patients with disease progression at 3-month follow-up (10.68 ± 3.88 s(-1)) was significantly different (p < 0.01) from that of patients with stable disease at 3-month follow-up (6.94 ± 3.12 s(-1)). Pre-treatment maximum ΔR2* of patients with disease progression at 6-month follow-up was not significantly different from that of patients with stable disease at 6-month follow-up, although a trend was noted (p = 0.08). Pre-treatment clinical factors were not significantly different between progressive and stable patients at 3- and 6-month follow-up. Tumor progression rate was significantly higher in patients with a higher pre-treatment maximum ΔR2* than in those with a lower pre-treatment maximum ΔR2* (median progression time, 38 vs 138 days, p < 0.01, using a cut-off value of 8.13 s(-1) as determined by ROC analysis). In conclusion, DSC-MRI may predict early progression in patients with advanced pancreatic cancer undergoing chemotherapy.
本研究旨在评估动态磁敏感对比磁共振成像（DSC-MRI）能否预测晚期胰腺癌对化疗的反应。DSC-MRI 采用对比剂团注后梯度回波回波平面成像进行。共纳入 54 例计划接受化疗的晚期胰腺癌患者。使用半自动计算机分析计算 ΔR2*，该分析能够在 DSC-MRI 期间跟踪移动病变。在 3 个月随访时，比较进展性疾病和稳定疾病患者的治疗前最大 ΔR2和临床因素（包括性别、年龄、肿瘤分期（UICC III/IV）、初始肿瘤大小和化疗方案），并在 6 个月随访时比较进展性疾病和稳定疾病患者的治疗前最大 ΔR2。使用受试者工作特征（ROC）分析和 Kaplan-Meier 方法与对数秩检验评估治疗前最大 ΔR2与早期进展（即在 3 个月随访时）之间的关系。在 3 个月随访时疾病进展患者的治疗前最大 ΔR2（10.68 ± 3.88 s(-1))）显著不同于（p<0.01）3 个月随访时稳定疾病患者的治疗前最大 ΔR2*（6.94 ± 3.12 s(-1))）。在 6 个月随访时疾病进展患者的治疗前最大 ΔR2与 6 个月随访时稳定疾病患者的治疗前最大 ΔR2无显著差异，尽管有趋势（p=0.08）。在 3 个月和 6 个月随访时，进展性和稳定性患者的治疗前临床因素无显著差异。与治疗前最大 ΔR2较低的患者相比，治疗前最大 ΔR2较高的患者肿瘤进展率显著更高（中位进展时间，38 天与 138 天，p<0.01，使用 ROC 分析确定的 8.13 s(-1)的截断值）。总之，DSC-MRI 可能预测接受化疗的晚期胰腺癌患者的早期进展。
