整合动态对比增强磁共振成像和扩散峰度成像用于鼻咽癌新辅助化疗评估。
Integrating dynamic contrast-enhanced magnetic resonance imaging and diffusion kurtosis imaging for neoadjuvant chemotherapy assessment of nasopharyngeal carcinoma.
机构信息
Department of Radiology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, Fujian Province, P.R. China.
Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, Fujian Province, P.R. China.
出版信息
J Magn Reson Imaging. 2018 Nov;48(5):1208-1216. doi: 10.1002/jmri.26164. Epub 2018 Apr 25.
BACKGROUND
Since neoadjuvant chemotherapy (NAC) has proven a benefit for locally advanced nasopharyngeal carcinoma (NPC), early response evaluation after chemotherapy is important to implement individualized therapy for NPC in the era of precision medicine.
PURPOSE
To determine the combined and independent contribution between dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and diffusion kurtosis imaging (DKI) in the early monitoring of NAC response for NPC.
STUDY TYPE
Prospective.
POPULATION
Fifty-three locally advanced NPC patients.
FIELD STRENGTH/SEQUENCE: Four examinations before and at 4, 20, and 40 days after NAC initiation were performed at 3T MRI including DCE-MRI and DKI (b values = 0, 500, 1000, 1500 s/mm ).
ASSESSMENT
DCE-MRI parameters (K [the volume transfer constant of Gd-DTPA], k [rate constant], ν [the extracellular volume fraction of the imaged tissue], and ν [the blood volume fraction]) and DKI parameters (D [apparent diffusion for non-Gaussian distribution] and K [apparent kurtosis coefficient]) were analyzed using dedicated software.
STATISTICAL TESTS
MRI parameters and their corresponding changes were compared between responders and nonresponders after one or two NAC cycles treatment using independent-samples Student's t-test or Mann-Whitney U-test depending on the normality contribution test and then followed by logistic regression and receiver operating characteristic curve (ROC) analyses.
RESULTS
The responder group (RG) patients presented significantly higher mean K and D values at baseline and larger , Δv , and ΔD values after either one or two NAC cycles compared with the nonresponder group (NRG) patients (all P < 0.05). ROC analyses demonstrated the higher diagnostic accuracy of combined DCE-MRI and DKI model to distinguish nonresponders from responders after two NAC cycles than using DCE-MRI (0.987 vs. 0.872, P = 0.033) or DKI (0.987 vs. 0.898, P = 0.047) alone.
DATA CONCLUSION
Combined DCE-MRI and DKI models had higher diagnostic accuracy for NAC assessment compared with either model used independently.
LEVEL OF EVIDENCE
2 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2018;47:1208-1216.
背景
新辅助化疗（NAC）已被证明对局部晚期鼻咽癌（NPC）有益，因此化疗后早期疗效评估对于精准医学时代 NPC 的个体化治疗至关重要。
目的
确定动态对比增强磁共振成像（DCE-MRI）和扩散峰度成像（DKI）在 NPC 患者 NAC 早期疗效监测中的联合及独立价值。
研究类型
前瞻性。
研究人群
53 例局部晚期 NPC 患者。
磁场强度/序列：在 3T MRI 上进行了 4 次检查，分别在 NAC 治疗前和治疗后第 4、20、40 天进行，包括 DCE-MRI 和 DKI（b 值=0、500、1000、1500 s/mm ）。
评估
使用专用软件分析 DCE-MRI 参数（K[钆二乙烯五胺五醋酸的容积转移常数]、k[速率常数]、ν[成像组织的细胞外容积分数]和ν[血容量分数]）和 DKI 参数（D[非高斯分布的表观扩散系数]和 K[表观峰度系数]）。
统计学方法
采用独立样本 t 检验或 Mann-Whitney U 检验，根据正态性检验结果，比较一个或两个 NAC 周期治疗后应答者和无应答者的 MRI 参数及其相应变化，然后进行逻辑回归和受试者工作特征曲线（ROC）分析。
结果
与无应答者组（NRG）相比，应答者组（RG）患者的基线时平均 K 值和 D 值较高，且一个或两个 NAC 周期后，平均 Δv 和 ΔD 值的变化也较大（均 P<0.05）。ROC 分析显示，与 DCE-MRI（0.872）或 DKI（0.898）相比，联合 DCE-MRI 和 DKI 模型在两个 NAC 周期后区分应答者和无应答者的诊断准确性更高（0.987 vs. 0.872，P=0.033；0.987 vs. 0.898，P=0.047）。
数据结论
与单独使用任何一种模型相比，联合 DCE-MRI 和 DKI 模型对 NAC 评估具有更高的诊断准确性。
证据水平
2 技术功效：2 级。JMRI. 2018；47：1208-1216.
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