弥散加权磁共振成像在放射治疗肝细胞癌患者治疗反应评估中的作用。

The role of diffusion-weighted magnetic resonance imaging in the treatment response evaluation of hepatocellular carcinoma patients treated with radiation therapy.

机构信息

Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

出版信息

Int J Radiat Oncol Biol Phys. 2014 Jul 15;89(4):814-21. doi: 10.1016/j.ijrobp.2014.03.020.

DOI:10.1016/j.ijrobp.2014.03.020

PMID:24969795

Abstract

PURPOSE

We investigated the role of diffusion-weighted magnetic resonance imaging (DW MRI) as a response evaluation indicator for hepatocellular carcinoma (HCC) treated with radiation therapy (RT).

METHODS AND MATERIALS

Inclusion criteria of this retrospective study were DW MRI acquisition within 1 month before and 3 to 5 months after RT. In total, 48 patients were enrolled. Two radiation oncologists measured the apparent diffusion coefficient (ADC). Possible predictive factors, including alteration of the ADC value before and 3 to 5 month after RT, in relation to local progression-free survival (LPFS) were analyzed and compared.

RESULTS

Three months after RT, 6 patients (12.5%) showed a complete response, and 27 patients (56.3%) showed a partial response when evaluated using the modified response evaluation criteria in solid tumors (mRECIST). The average ADC ± SD values were 1.21 ± 0.27 ( × 10(-3) mm(2)/s) before and 1.41 ± 0.36 ( × 10(-3) mm(2)/s) after RT (P<.001). The most significant prognostic factor related to LPFS was mRECIST (P<.001). The increment of ADC value (≥ 20%) was also a significant factor (P=.02), but RECIST (version 1.1; P=.11) was not. When RECIST was combined with the increment of ADC value (≥ 20%), the LPFS rates were significantly different between the groups (P=.004), and the area under the curve value (0.745) was comparable with that of mRECIST (0.765).

CONCLUSIONS

ADC value change before and after RT in HCC was closely related to LPFS. ADC value and RECIST may substitute for mRECIST in patients who cannot receive contrast agents.

摘要

目的

我们研究了弥散加权磁共振成像（DW MRI）作为放射治疗（RT）治疗肝细胞癌（HCC）的反应评估指标的作用。

方法与材料

本回顾性研究的纳入标准为 RT 前 1 个月内和 RT 后 3 至 5 个月内采集 DW MRI。共纳入 48 例患者。两名放射肿瘤学家测量了表观扩散系数（ADC）。分析并比较了 ADC 值在 RT 前后的变化与局部无进展生存期（LPFS）之间的可能预测因素。

结果

在 RT 后 3 个月，根据改良实体瘤反应评价标准（mRECIST），6 例（12.5%）患者完全缓解，27 例（56.3%）患者部分缓解。RT 前 ADC 值的平均值±标准差为 1.21±0.27（×10(-3)mm(2)/s），RT 后为 1.41±0.36（×10(-3)mm(2)/s）（P<.001）。与 LPFS 最显著相关的预后因素是 mRECIST（P<.001）。ADC 值的增加（≥20%）也是一个显著因素（P=.02），但 RECIST（1.1 版；P=.11）不是。当 RECIST 与 ADC 值的增加（≥20%）相结合时，两组之间的 LPFS 率有显著差异（P=.004），曲线下面积值（0.745）与 mRECIST（0.765）相当。