局部进展期直肠癌新辅助放化疗的疗效评价：动态对比增强 MRI 纹理分析。
Response to neoadjuvant chemoradiotherapy for locally advanced rectum cancer: Texture analysis of dynamic contrast-enhanced MRI.
机构信息
Department of Radiology, First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
GE Healthcare, Shanghai, China.
出版信息
J Magn Reson Imaging. 2019 Mar;49(3):885-893. doi: 10.1002/jmri.26254. Epub 2018 Aug 5.
BACKGROUND
Tumor heterogeneity can be assessed by texture analysis (TA). TA has been applied using diffusion-weighted imaging and apparent diffusion coefficient maps to predict pathological responses to preoperative chemoradiation therapy (CRT) in patients with locally advanced rectal cancer (LARC).
PURPOSE
To evaluate the texture parameters obtained from K maps derived from dynamic contrast-enhanced (DCE)-MRI for predicting pathological responses to preoperative CRT for LARCs.
STUDY TYPE
Retrospective.
POPULATION
Altogether, 83 patients (26 women, 57 men) with rectal cancer met the inclusion criteria.
FIELD STRENGTH/SEQUENCE: 3.0T/T -weighted DCE-MRI sequence.
ASSESSMENT
After CRT, each tumor was assessed by a pathologist who assigned a tumor regression grade (TRG), thereby identifying pathologically complete responders (pCR; TRG 1) and good responders (GR; TRG1 + TRG2). TA was then applied to the DCE-MRI K maps. The K value, several TA parameters, and tumor volumes were calculated.
STATISTICAL TESTS
The Shapiro-Wilk test was used to verify that the data had normal distribution. Results of parameters measured before and after CRT were compared using paired-sample t-tests. Value changes of each parameter in the combined pCR/GR group were compared using independent sample t-tests. Receiver operating characteristic curves and areas under the curve (AUC) were calculated to assess the diagnostic performance of each parameter related to CRT effectiveness.
RESULTS
There were 15 pCR (16.9%) and 21 GR (25.3%) patients. Tumor volume, mean K , entropy, and correlation decreased and energy values increased significantly in these groups compared with those of the non-PCR and non-GR groups. ΔCorrelation (Δcorrelation = postcorrelation - precorrelation) was found to be a valuable parameter for identifying pCR/GR patients (AUC 0.895, sensitivity 86.7%, specificity 81.8%).
DATA CONCLUSION
TA parameters from the DCE-MRI K map can predict the efficacy of CRT for treating LARCs. Also, Δcorrelation may be useful for identifying patients who will be responsive to CRT.
LEVEL OF EVIDENCE
4 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2019;49:885-893.
背景
肿瘤异质性可以通过纹理分析（TA）进行评估。TA 已应用于扩散加权成像和表观扩散系数图，以预测局部晚期直肠癌（LARC）患者术前放化疗（CRT）的病理反应。
目的
评估从动态对比增强（DCE）-MRI 衍生的 K 图获得的纹理参数，以预测 LARC 术前 CRT 的病理反应。
研究类型
回顾性。
人群
共有 83 名符合纳入标准的直肠癌患者（26 名女性，57 名男性）。
磁场强度/序列：3.0T/T1 加权 DCE-MRI 序列。
评估
在 CRT 后，由病理学家对每个肿瘤进行评估，病理学家分配肿瘤消退分级（TRG），从而确定病理完全缓解者（pCR；TRG1）和良好缓解者（GR；TRG1+TRG2）。然后将 TA 应用于 DCE-MRI K 图。计算 K 值、几个 TA 参数和肿瘤体积。
统计检验
使用 Shapiro-Wilk 检验验证数据是否具有正态分布。使用配对样本 t 检验比较 CRT 前后参数的结果。使用独立样本 t 检验比较联合 pCR/GR 组中每个参数的变化值。计算受试者工作特征曲线和曲线下面积（AUC），以评估与 CRT 效果相关的每个参数的诊断性能。
结果
有 15 例 pCR（16.9%）和 21 例 GR（25.3%）患者。与非 pCR 和非 GR 组相比，这些组的肿瘤体积、平均 K 值、熵和相关性降低，能量值升高。相关性变化（Δcorrelation=postcorrelation-precorrelation）被发现是一种识别 pCR/GR 患者的有价值的参数（AUC 0.895，灵敏度 86.7%，特异性 81.8%）。
数据结论
DCE-MRI K 图的 TA 参数可预测 LARC 患者 CRT 的疗效。此外，Δcorrelation 可能有助于识别对 CRT 有反应的患者。
证据水平
4 级技术功效：3 期 J. Magn. Reson. Imaging 2019;49:885-893.
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