磁其振表观扩散系数对肝转移瘤化疗效果的预测价值

摘要

目的 探讨磁共振弥散加权成像(DWI)表观扩散系数(ADC)对肝转移瘤化疗疗效的预测价值.方法 选取本院就诊的胃肠道癌发生肝脏转移的患者80例(转移病灶148个),比较治疗前、治疗后2周和12周转移瘤最大直径,根据治疗后12周肿瘤最大直径变化分为有效组及无效组.比较有效组及无效组治疗前、治疗后2周和12周的ADC值.分析ADC值与肿瘤直径的相关性.利用ROC曲线分析治疗前ADC值和治疗后2周ADC变化率用于预测患者对化疗的效果.结果 治疗前,有效组病灶的ADC值平均值显著低于无效组(P=0.002);在肿瘤ADC值的变化上,化疗2周、12周后,有效组的ADC较化疗前均显著上升,而化疗无效组的ADC则无显著变化;治疗前ADC与肿瘤的直径变化呈现负相关(r=-0.662,P=0.000);治疗后2周ADC变化率与肿瘤的直径变化也呈现负相关关系(r=-0.846,P=0.000).ROC曲线结果表明,以治疗前ADC值预测转移瘤化疗效果的AUC为0.914;治疗后2周ADC变化率预测转移瘤的AUC为0.893;二者联用时对于转移瘤化疗评估的AUC为0.959.结论 化疗前ADC值、治疗后2周ADC值的变化率以及二者联用在胃肠道癌肝转移化疗疗效预测上有较高的临床应用价值.%Objective To explore the predictive value of diffusion weighted magnetic resonance imaging (DWI) and apparent diffusion coefficients (ADC) in chemotherapy for patients with metastatic tumor of liver.Methods Eighty patients (with 148 lesions) with gastrointestinal hepatic metastases were enrolled.The maximum diameters of the metastases tumor were compared before and after the treatment,and patients were divided into sensitive group and ineffective group according to the tumor diameter.Correlation between the ADC value and the diameter was analyzed,and the ROC curve was drawn to predict the sensitivity and specificity of the therapy.Results The maximum diameter of the tumor was similar in the two groups,and the ADC value of the sensitive group was significantly less than the ineffective group before treatment (P =0.000).In the aspect of ADC,the ADC value increased significantly in the sensitive group after 2 weeks or 12 weeks of treatment.The ADC value before treatment had negative correlation with the change of the diameter of the tumor(r =-0.662,P =0.000),and the change of ADC value after two weeks of treatment had negative correlation with the change of the diameter of the tumor as well(r =-0.846,P =0.000).The AUC value for ADC before treatment was 0.914.The AUC value for the changing rate of ADC after two weeks of treatment was 0.893.In combination of the ADC value before and after two weeks of treatment,the AUC increased significantly.Conclusion The ADC value before treatment,the change of ADC value after two weeks of treatment and collaborative assessment has favorable effective functions for the forecast of the chemotherapy effect on patients with colorectal and gastric cancer.