扩散加权成像对原发性中枢神经系统淋巴瘤放疗疗效的预测价值

摘要

Objective To investigate whether the apparent diffusion coefficient(ADC) value derived from pretherapeutic diffusion-weighted imaging(DWI) in primary central nervous system lymphoma(PCNSL) was a prognostic indicator reflecting both progression-free survival(PFS) and response to radiotherapy.Methods Retrospective observation of clinical characteristics and findings of pretherapeutic DWI were carried out in 28 patients with PCNSL received radiotherapy.Maximum(ADCmax), minimum (ADCmin), and the average of mean (ADCmean) ADC values of the enhancing tumor volume were measured.The difference of PFS was investigated bychi-square test about potential prognostic parameters.Various ADC values and clinical features were analyzed using an independent sample t-test between initial complete response(CRi) and initial partial response(PRi) groups at the end of radiotherapy.Results Patients with CRi, lower Ki-67 level, higher Karnofsky performance status(KPS), higher ADCmin or ADCmean showed better PFS.PFS was not correlated with age, number of intensified foci and gender.There was a significant difference in PFS, KPS, ADCmean and ADCmin between CRi and PRi.Conclusion ADC measurements are useful predictors for PFS and response to radiotherapy in PCNSL.%目的 探讨扩散加权成像(DWI)对原发性中枢神经系统淋巴瘤(PCNSL)疗效预测价值.方法 选择2010年3月至2013年12月太和县人民医院和中国人民解放军第105医院经临床和病理证实的28例PCNSL,测肿瘤最小表观扩散系数值(ADCmin)、最大ADC值(ADCmax)及平均ADC值(ADCmean),分析不同ADC值间无进展生存期(PFS)的差异.放疗后即刻评估疗效,将患者分为初始疗效完全缓解组(CRi)和部分缓解组(PRi),比较组间各指标的差异.结果 CRi者(P=0.031)、低Ki-67表达(P=0.008)、高KPS(P=0.031)、高ADCmin(P=0.031)或者ADCmean(P=0.003)有较好PFS,年龄、强化灶数目、性别不影响PFS.CRi与PRi患者的PFS、KPS、ADCmin、ADCmean差异有统计学意义(P<0.05).结论 DWI可预测PCNSL放疗反应性和PFS.