使用动态对比增强整合式 MR-PET 评估立体定向体部放疗在非小细胞肺癌患者中的疗效。
Response assessment of stereotactic body radiation therapy using dynamic contrast-enhanced integrated MR-PET in non-small cell lung cancer patients.
机构信息
Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan.
Department of Medical Imaging, National Taiwan University, Hospital and National Taiwan, University College of Medicine, Taipei, Taiwan.
出版信息
J Magn Reson Imaging. 2018 Jan;47(1):191-199. doi: 10.1002/jmri.25758. Epub 2017 May 8.
PURPOSE
To evaluate the response in patients undergoing SBRT using dynamic contrast-enhanced (DCE) integrated magnetic resonance positron emission tomography (MR-PET). Stereotactic body radiation therapy (SBRT) is efficacious as a front-line local treatment for non-small cell lung cancer (NSCLC).
MATERIALS AND METHODS
We prospectively enrolled 19 lung tumors in 17 nonmetastatic NSCLC patients who were receiving SBRT as a primary treatment. They underwent DCE-integrated 3T MR-PET before and 6 weeks after SBRT. The following image parameters were analyzed: tumor size, standardized uptake value (SUV), apparent diffusion coefficient, K , k , v , v , and iAUC . Chest computed tomography (CT) was performed at 3 months after SBRT.
RESULTS
SBRT treatment led to tumor changes including significant decreases in the SUV (-61%, P < 0.001), K mean (-72%, P = 0.005), K standard deviation (SD; -85%, P = 0.046), k mean (-53%, P = 0.014), k SD (-63%, P = 0.001), and v SD (-58%, P = 0.002). The PET SUV was correlated with the MR k mean (P = 0.002) and k SD (P < 0.001). The percentage reduction in K mean (P < 0.001) and k mean (P = 0.034) at 6 weeks post-SBRT were significantly correlated with the percentage reduction in tumor size, as measured using CT at 3 months after SBRT. Univariate analyses revealed a trend toward disease progression when the initial SUV > 10 (P = 0.083).
CONCLUSION
In patients with NSCLC who are receiving SBRT, DCE-integrated MR-PET can be used to evaluate the response after SBRT and to predict the local treatment outcome.
LEVEL OF EVIDENCE
2 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:191-199.
目的
使用动态对比增强（DCE）集成磁共振正电子发射断层扫描（MR-PET）评估行立体定向体部放疗（SBRT）患者的反应。SBRT 是治疗非小细胞肺癌（NSCLC）的有效一线局部治疗方法。
材料与方法
我们前瞻性纳入 17 例非转移性 NSCLC 患者的 19 个肺部肿瘤，这些患者正在接受 SBRT 作为主要治疗方法。他们在 SBRT 前和 SBRT 后 6 周时接受了 DCE 集成 3T MR-PET 检查。分析了以下图像参数：肿瘤大小、标准化摄取值（SUV）、表观扩散系数、K'、k'、v'、v'和 iAUC。在 SBRT 后 3 个月时进行胸部 CT 检查。
结果
SBRT 治疗导致肿瘤发生变化，包括 SUV（-61%，P<0.001）、K 均值（-72%，P=0.005）、K 标准差（-85%，P=0.046）、k 均值（-53%，P=0.014）、k 标准差（-63%，P=0.001）和 v 标准差（-58%，P=0.002）显著降低。PET SUV 与 MR k 均值（P=0.002）和 k 标准差（P<0.001）相关。SBRT 后 6 周时 K 均值（P<0.001）和 k 均值（P=0.034）的百分比降低与 SBRT 后 3 个月时 CT 测量的肿瘤大小百分比降低显著相关。单变量分析显示，当 SUV 初始值>10 时，疾病进展呈趋势（P=0.083）。
结论
在接受 SBRT 的 NSCLC 患者中，DCE 集成的 MR-PET 可用于评估 SBRT 后的反应，并预测局部治疗结果。
证据水平
2 技术效果：1 级。J. Magn. Reson. Imaging 2018；47：191-199。
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