非小细胞肺癌：应用对比增强动态和弥散加权磁共振成像检测化疗早期疗效。
Non-small cell lung cancer: detection of early response to chemotherapy by using contrast-enhanced dynamic and diffusion-weighted MR imaging.
机构信息
Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
出版信息
Radiology. 2011 Nov;261(2):598-604. doi: 10.1148/radiol.11101503. Epub 2011 Aug 18.
PURPOSE
To evaluate the ability of dynamic contrast material-enhanced and diffusion-weighted (DW) magnetic resonance (MR) imaging to help detect early response to chemotherapy in patients with non-small cell lung cancer (NSCLC).
MATERIALS AND METHODS
This study was approved by the institutional review board, and written informed consent was obtained from all subjects. Twenty-eight patients with stage IIIB or IV NSCLC (17 women, 11 men; mean age, 64.8 years) who underwent chemotherapy were enrolled. All patients underwent MR imaging before and after the first course of chemotherapy. The time to peak enhancement, maximum enhancement ratio, and washout ratio were determined from the time-signal intensity curves of dynamic contrast-enhanced MR images. The apparent diffusion coefficient (ADC) of each lung carcinoma was calculated from DW MR images. The responses of these parameters to the first course of chemotherapy and the pretreatment ADC itself were compared with final tumor size reduction by using the Pearson correlation coefficient. Kaplan-Meier curves of progression-free survival and overall survival were generated, and comparisons between the group with a good response of the significant parameter (upper 50th percentile) and that with a poor response of the significant parameter (lower 50th percentile) were performed by using a two-sided log-rank test.
RESULTS
Significant correlation was found only between early ADC change and final tumor size reduction rate (r(2) = 0.41, P = .00025). The median progression-free survival for the group with a good increase in ADC was 12.1 months, and that for the group with a stable or decreased ADC was 6.67 months (P = .021), while median overall survival was 22.4 and 12.3 months, respectively (P = .048).
CONCLUSION
ADC seems to be a promising tool for monitoring the early response to or predicting prognosis after chemotherapy of NSCLC.
目的
评估动态对比增强和弥散加权（DW）磁共振（MR）成像在检测非小细胞肺癌（NSCLC）患者化疗早期反应中的能力。
材料与方法
本研究经机构审查委员会批准，并获得所有患者的书面知情同意。共纳入 28 例接受化疗的 IIIB 期或 IV 期 NSCLC 患者（17 名女性，11 名男性；平均年龄，64.8 岁）。所有患者均在化疗前和化疗后进行 MR 成像。从动态对比增强 MR 图像的时间-信号强度曲线确定达峰增强时间、最大增强比和洗脱率。从 DW MR 图像计算每个肺癌的表观扩散系数（ADC）。采用 Pearson 相关系数比较这些参数对第一疗程化疗的反应与治疗前 ADC 本身与最终肿瘤大小缩小之间的相关性。绘制无进展生存和总生存的 Kaplan-Meier 曲线，并通过双侧对数秩检验比较显著参数（上 50%分位数）反应良好组和显著参数（下 50%分位数）反应不良组之间的差异。
结果
仅在早期 ADC 变化与最终肿瘤缩小率之间发现显著相关性（r²=0.41，P=.00025）。ADC 升高良好组的无进展中位生存时间为 12.1 个月，ADC 稳定或降低组为 6.67 个月（P=.021），而总生存中位时间分别为 22.4 个月和 12.3 个月（P=.048）。
结论
ADC 似乎是监测 NSCLC 化疗早期反应或预测预后的一种很有前途的工具。
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