Reischauer Carolin, Froehlich Johannes Malte, Pless Miklos, Binkert Christoph Andreas, Koh Dow-Mu, Gutzeit Andreas
Institute of Radiology and Nuclear Medicine, Clinical Research Unit, Hirslanden Hospital St. Anna, Lucerne, Switzerland; Department of Radiology, Cantonal Hospital Winterthur, Winterthur, Switzerland; Department of Radiology, Paracelsus Medical University Salzburg, Salzburg, Austria.
Institute of Radiology and Nuclear Medicine, Clinical Research Unit, Hirslanden Hospital St. Anna, Lucerne, Switzerland.
PLoS One. 2014 Oct 7;9(10):e108052. doi: 10.1371/journal.pone.0108052. eCollection 2014.
The aim of this study was to prospectively evaluate the feasibility of monitoring treatment response to chemotherapy in patients with non-small cell lung carcinoma using functional diffusion maps (fDMs).
This study was approved by the Cantonal Research Ethics Committee and informed written consent was obtained from all patients. Nine patients (mean age = 66 years; range = 53-76 years, 5 females, 4 males) with overall 13 lesions were included. Imaging was performed within two weeks before initiation of chemotherapy and at one, two, and six weeks after initiation of chemotherapy. Imaging included a respiratory-triggered diffusion-weighted sequence including three b-factors (100, 600, and 800 s/mm2). Treatment response was defined by change in tumor diameter on computed tomography (CT) after two cycles of chemotherapy. Changes in the apparent diffusion coefficient (ADC) on a per-lesion basis and the percentages of voxel with significantly increased or decreased ADCs on fDMs were analyzed using repeated measures analysis of variance (ANOVA). Changes in tumor size were used as covariate to examine the ability of ADCs and fDM parameters to predict treatment response.
Repeated measures ANOVA revealed that the percentage of voxels with increased ADCs on fDMs (p = 0.002) as well as the mean ADC increase (p = 0.011) were significantly higher in good responders with a large reduction in tumor size on CT.
Our results indicate that the percentage of voxels with significantly increased ADCs on fDMs seems to be a promising biomarker for early prediction of treatment response in patients with non-small cell lung carcinoma. Contrary to averaged values, this approach allows the spatial heterogeneity of treatment response to be resolved.
本研究旨在前瞻性评估使用功能扩散图（fDMs）监测非小细胞肺癌患者化疗反应的可行性。
本研究经州研究伦理委员会批准，并获得所有患者的书面知情同意。纳入9例患者（平均年龄 = 66岁；范围 = 53 - 76岁，5例女性，4例男性），共13个病灶。在化疗开始前两周内以及化疗开始后1周、2周和6周进行成像。成像包括呼吸触发的扩散加权序列，包含三个b值（100、600和800 s/mm²）。化疗反应通过两个周期化疗后计算机断层扫描（CT）上肿瘤直径的变化来定义。使用重复测量方差分析（ANOVA）分析每个病灶的表观扩散系数（ADC）变化以及fDMs上ADC显著增加或减少的体素百分比。将肿瘤大小的变化用作协变量，以检验ADC和fDM参数预测治疗反应的能力。
重复测量ANOVA显示，在CT上肿瘤大小大幅减小的良好反应者中，fDMs上ADC增加的体素百分比（p = 0.002）以及平均ADC增加（p = 0.011）显著更高。
我们的结果表明，fDMs上ADC显著增加的体素百分比似乎是早期预测非小细胞肺癌患者治疗反应的一个有前景的生物标志物。与平均值相反，这种方法能够解决治疗反应的空间异质性问题。
