直肠癌新辅助化疗后患者疗效预测中体素内不相干运动和动态对比增强灌注的作用
Role of Intravoxel Incoherent Motion and Dynamic-Contrast-Enhanced Perfusion in Response Prediction of Patients with Colorectal Cancer after Neoadjuvant Chemotherapy.
机构信息
Department of Technology of Radiology and Radiotherapy, Allied Medical Science School, Tehran University of Medical Sciences, Tehran, Iran.
Department of Radiology, Hilla University College, Babylon, Iraq.
出版信息
Asian Pac J Cancer Prev. 2024 Sep 1;25(9):3029-3037. doi: 10.31557/APJCP.2024.25.9.3029.
BACKGROUND
Colorectal cancer (CRC) is a complex malignancy requiring multimodal treatment strategies, including neoadjuvant chemoradiation therapy (Neo-CRT), to improve patient outcomes. However, the response to Neo-CRT varies among individuals, which necessitates the development of reliable predictors of treatment response. The present study aimed to investigate the role of intravoxel incoherent motion (IVIM) and dynamic contrast-enhanced (DCE) perfusion in predicting treatment response in CRC patients after Neo-CRT.
METHODS
This study was conducted on patients diagnosed with locally advanced CRC who received Neo-CRT. IVIM and DCE perfusion imaging were performed before and after CRT. Quantitative parameters, including perfusion fraction (f), diffusion coefficient (D), and transfer constant (Ktrans), were calculated from the imaging data. Treatment response was assessed based on the pathological response after surgery. Statistical data were analyzed in SPSS v. 26 using the t-test and the chi-square method.
RESULTS
A total of 51 patients (female: male = 22:29, mean age = 58.14±3.49) participated in the study. Among all the patients, 15 (29.4%) cases had good responses, while 36 (70.58%) cases did not respond to treatment. All DCE parameters showed higher sensitivity and specificity than IVIM D*. Ve, Kep, and DCE Ktrans indicated significant predictive power for treatment response. Ktrans was the most accurate parameter for predicting response to treatment. Overall sensitivity and specificity of DCE were 88.8% [95% CI: 80-95.6], and 80 % [95% CI: 65-90], and those of IVIM were 65.5% and 81%, respectively. Sensitivity and specificity for DCE + IVIM were 79.5% and 93.5%, and those of DCE + IVIM + standard magnetic resonance imaging were 80.2% and 86%, respectively.
CONCLUSION
IVIM and DCE perfusion imaging could serve as promising tools for predicting treatment response in CRC patients after Neo-CRT.
背景
结直肠癌（CRC）是一种复杂的恶性肿瘤，需要采用新辅助放化疗（Neo-CRT）等多种治疗策略来改善患者的预后。然而，个体对 Neo-CRT 的反应存在差异，因此需要开发可靠的治疗反应预测指标。本研究旨在探讨体素内不相干运动（IVIM）和动态对比增强（DCE）灌注在预测 Neo-CRT 后 CRC 患者治疗反应中的作用。
方法
本研究纳入了接受 Neo-CRT 的局部晚期 CRC 患者。在 CRT 前后进行 IVIM 和 DCE 灌注成像。从成像数据中计算出灌注分数（f）、扩散系数（D）和转运常数（Ktrans）等定量参数。根据手术后的病理反应评估治疗反应。统计数据采用 SPSS v. 26 中的 t 检验和卡方检验进行分析。
结果
共纳入 51 例患者（女性：男性=22:29，平均年龄=58.14±3.49）。所有患者中，15 例（29.4%）为治疗反应良好，36 例（70.58%）为治疗反应不佳。所有 DCE 参数的敏感性和特异性均高于 IVIM D*。Ve、Kep 和 DCE Ktrans 对治疗反应具有显著的预测能力。Ktrans 是预测治疗反应最准确的参数。DCE 的总敏感性和特异性分别为 88.8%[95%CI：80-95.6]和 80%[95%CI：65-90]，IVIM 的敏感性和特异性分别为 65.5%和 81%。DCE+IVIM 的敏感性和特异性分别为 79.5%和 93.5%，DCE+IVIM+标准磁共振成像的敏感性和特异性分别为 80.2%和 86%。
结论
IVIM 和 DCE 灌注成像可以作为预测 Neo-CRT 后 CRC 患者治疗反应的有前途的工具。
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