3.0T-MRI DWI在评价晚期肺癌同步放化疗疗效中的应用

摘要

目的 探讨3.0T MRI弥散加权成像 (DWI) 在评价晚期肺癌同步放化疗疗效中的临床应用价值.方法 对经穿刺病理证实的59例晚期肺癌患者进行3.0T-MRI DWI检查, 测量肿瘤的表观弥散系数 (apparent diffusion coefficient, ADC) 值与肿瘤细胞密度 (TCD) 值, 分析DWI对肺癌病灶的显示能力, 比较肺癌ADC值与TCD之间的相关性.结果 59例肺癌病灶在DWI像上均呈明显高信号, 癌肿平均ADC均值为 (993±170) ×10-6mm2/s, 明显小于胸大肌ADC均值 (1388±148) ×10-6mm2/s, 两者之间有显著差异 (P<0.001);非小细胞肺癌 (NSCLC) 与小细胞癌 (SCLC) 之间病灶ADC均值存在差异 (P=0.005<0.05);共取得45例TCD值, NSCLC与SCLC之间TCD存在差异 (P=0.047<0.05);肺癌病灶ADC值与病理TCD之间呈负相关 (P=0.001, 相关系数=-0.534) .结论 通过DWI检查可以清晰的显示肺癌肿瘤累及区域, 不仅有利于SCLC与NSCLC的鉴别诊断, 并且能够间接地反映肿瘤TCD值, 为临床监测肺癌治疗疗效和预后提供可靠的依据.%Objective To assess the clinical applications of 3.0 T magnetic resonance (MRI) diffusion weighted imaging (DWI) in evaluating the efficacy of synchronous radiotherapy and chemotherapy for advanced lung cancer. Methods 59 patients with lung cancer confirmed by biopsy were examined with 3.0 T-MRI DWI. The values of apparent diffusion coefficient (ADC) and tumor cell density (TCD) were measured. We analyzed the ability of DWI to display the lesions of lung cancer and compared the correlation between the ADC value and TCD of lung cancer. Results 59 cases of lung cancer showed obviously high signal on DWI. The mean average ADC of the cancer was (993±170) ×10-6 mm2/s, which was significantly less than the ADC mean of the pectoralis major muscle (1388±148) ×10-6 mm2/s. There was statistically significant difference between the two (P<0.001). There was a difference in the mean value of ADC between non small cell lung cancer (NSCLC) and small cell carcinoma (SCLC) (P=0.005<0.05). A total of 45 TCD values were obtained. There was a significant statistical difference in TCD between NSCLC and SCLC (P=0.047 < 0.05).There was a negative correlation between the ADC value and pathological TCD of lung cancer (P=0.001, correlation coefficient =-0.534). Conclusion The involvement area of lung cancer can be clearly demonstrated by DWI examination. It is not only beneficial to the differential diagnosis of SCLC and NSCLC, but also can reflect the TCD value of the tumor indirectly theseby providing, reliable basis for monitoring therapeutic effect and prognosis of lung cancer.