基于全肿瘤容积的体素内不相干运动定量参数评估局部进展期直肠癌新辅助化疗的病理完全缓解。
Quantitative intravoxel incoherent motion parameters derived from whole-tumor volume for assessing pathological complete response to neoadjuvant chemotherapy in locally advanced rectal cancer.
机构信息
Department of Radiology, China-Japan Friendship Hospital, Beijing, China.
Philips Healthcare, Shatin, New Territories, Hong Kong, China.
出版信息
J Magn Reson Imaging. 2018 Jul;48(1):248-258. doi: 10.1002/jmri.25931. Epub 2017 Dec 27.
BACKGROUND
Many locally advanced rectal cancer (LARC) patients can benefit from neoadjuvant chemotherapy (NACT), with some achieving a pathological complete response (pCR). However, there is limited research reporting on the value of intravoxel incoherent motion (IVIM) in monitoring pCR in patients with LARC.
PURPOSE
To identify whether IVIM parameters derived from whole-tumor volume (WTV) before and after NACT could accurately assess pCR in patients with LARC.
STUDY TYPE
Prospective patient control study.
POPULATION
Fifty-one patients with LARC before and after NACT, prior to surgery.
FIELD STRENGTH/SEQUENCE: IVIM-diffusion imaging at 3T.
ASSESSMENT
Apparent diffusion coefficient (ADC), slow diffusion coefficient (D), fast diffusion coefficient (D*), and perfusion-related diffusion fraction (f) values were obtained on diffusion-weighted magnetic resonance images (DW-MRI) using WTV methods and calculated using a biexponential model before and after NACT.
STATISTICAL TESTS
DWI-derived ADC and IVIM-derived parameters and their percentage changes (ΔADC%, ΔD%, ΔD*%, and Δf%) were compared using independent-samples t-test and Mann-Whitney U-test between the pCR and non-pCR groups. The diagnostic performance of IVIM parameters and their percentage changes were evaluated using receiver operating characteristic curves.
RESULTS
Compared with the non-pCR group, the pCR group exhibited significantly lower pre-ADC (P = 0.003) and pre-D values (P = 0.024), and significantly higher post-f (P = 0.002), ΔADC % (P = 0.002), ΔD% (P = 0.001), and Δf% values (P = 0.017). Receiver operating characteristic curves showed that the pre-D value had the best specificity (95.12%) and accuracy (86.27%) in predicting the pCR status, and ΔD% had the highest area under the curve (0.832) in assessing the pCR response to NACT.
DATA CONCLUSIONS
The IVIM-derived D value is a promising tool in predicting the pCR status before therapy. The percentage changes in D values after therapy may help assess the pCR status prior to surgery.
LEVEL OF EVIDENCE
2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2017.
背景
许多局部晚期直肠癌（LARC）患者可从新辅助化疗（NACT）中获益，部分患者可获得病理完全缓解（pCR）。然而，目前关于体素内不相干运动（IVIM）在监测 LARC 患者 pCR 中的价值的研究有限。
目的
确定 NACT 前后全肿瘤体积（WTV）的 IVIM 参数是否可准确评估 LARC 患者的 pCR。
研究类型
前瞻性患者对照研究。
人群
51 例接受 NACT 前后的 LARC 患者，均在术前进行。
磁场强度/序列：3T 下 IVIM 扩散成像。
评估
在 NACT 前后，使用 WTV 方法从扩散加权磁共振成像（DW-MRI）上获得表观扩散系数（ADC）、慢扩散系数（D）、快扩散系数（D*）和灌注相关扩散分数（f）值，并使用双指数模型进行计算。
统计学检验
采用独立样本 t 检验和 Mann-Whitney U 检验比较 pCR 组与非 pCR 组间 DWI 衍生 ADC 值和 IVIM 衍生参数及其百分比变化（ΔADC%、ΔD%、ΔD*%和 Δf%）。采用受试者工作特征曲线评估 IVIM 参数及其百分比变化的诊断性能。
结果
与非 pCR 组相比，pCR 组的术前 ADC 值（P=0.003）和术前 D 值（P=0.024）显著降低，术后 f 值（P=0.002）、ΔADC%（P=0.002）、ΔD%（P=0.001）和 Δf%值（P=0.017）显著升高。受试者工作特征曲线显示，术前 D 值在预测 pCR 状态时具有最佳的特异性（95.12%）和准确性（86.27%），而ΔD%在评估 NACT 对 pCR 的反应时具有最高的曲线下面积（0.832）。
数据结论
IVIM 衍生的 D 值有望成为预测治疗前 pCR 状态的工具。治疗后 D 值的百分比变化可能有助于术前评估 pCR 状态。
证据水平
2 技术功效：2 级 J. 磁共振成像 2017 年。
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