Tong Tong, Sun Yiqun, Gollub Marc J, Peng Weijun, Cai Sanjun, Zhang Zhen, Gu Yajia
Department of Radiology, Fudan University Shanghai Cancer Center, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, P.R. China.
Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
J Magn Reson Imaging. 2015 Sep;42(3):673-80. doi: 10.1002/jmri.24835. Epub 2015 Feb 5.
To determine the ability of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) to predict pathological complete response (pCR) before preoperative chemoradiotherapy (CRT) in locally advanced rectal cancer.
In a prospective clinical trial, 38 enrolled patients underwent pre- and post-CRT DCE-MRI at 3.0T. The tumor length and the following perfusion parameters (K(trans) , kep , ve ) were measured for the tumor and compared between the pCR group and the non-pCR group, as well as before and after CRT. For categorical variable comparison, the Kruskal-Wallis test was used. P < 0.05 was considered significant.
No difference in tumor length was found between the pCR and non-pCR group pre- and post-CRT (P = 0.26 (0.15,0.45), 0.35 (0.21,0.52), respectively). Before CRT, the mean tumor K(trans) in the pCR group was significantly higher than in the non-pCR group (P = 0.01). A K(trans) of 0.66 emerged as the best cutoff for distinguishing pCR from non-pCR. Regarding kep and ve , significant differences were also observed between the pCR and non-pCR groups (P = 0.02, 0.01, respectively). The mean K(trans) , kep , and ve values post-CRT were lower in the pCR group than in the non-pCR group, although there was no significant difference (P = 0.10 (0.04,0.16), 0.11 (0.07,0.26), 0.10 (0.06,0.23), respectively).
Before neoadjuvant chemoradiotherapy in rectal cancer, DCE-MRI can distinguish between complete and incomplete response using a K(trans) threshold of 0.66 with a sensitivity of 100%.
确定动态对比增强磁共振成像（DCE-MRI）在局部晚期直肠癌术前放化疗（CRT）前预测病理完全缓解（pCR）的能力。
在一项前瞻性临床试验中，38例入组患者在3.0T下行CRT前后的DCE-MRI检查。测量肿瘤长度及以下灌注参数（Ktrans、kep、ve），并在pCR组和非pCR组之间以及CRT前后进行比较。对于分类变量比较，采用Kruskal-Wallis检验。P < 0.05被认为具有统计学意义。
CRT前后，pCR组和非pCR组的肿瘤长度无差异（分别为P = 0.26(0.15,0.45)，0.35(0.21,0.52)）。CRT前，pCR组的平均肿瘤Ktrans显著高于非pCR组（P = 0.01）。Ktrans为0.66是区分pCR和非pCR的最佳临界值。关于kep和ve，pCR组和非pCR组之间也观察到显著差异（分别为P = 0.02，0.01）。CRT后，pCR组的平均Ktrans、kep和ve值低于非pCR组，尽管无显著差异（分别为P = 0.10(0.04,0.16)，0.11(0.07,0.26)，0.10(0.06,0.23)）。
在直肠癌新辅助放化疗前，DCE-MRI可以使用0.66的Ktrans阈值区分完全缓解和不完全缓解，灵敏度为100%。
