| 郑德春,张潇潇,林浩,赖国静,任旺,陈英,陈韵彬.扩散峰度成像早期预测鼻咽癌颈部转移性淋巴结化疗疗效的初步研究[J].中国医学影像技术,2020,36(2): |
| 扩散峰度成像早期预测鼻咽癌颈部转移性淋巴结化疗疗效的初步研究 |
| Early Monitoring Chemotherapy Response of Metastatic Lymph Nodes of the Neck Region in Nasopharyngeal Carcinoma Using Diffusion Kurtosis Imaging: A primary study |
| 投稿时间：2019-04-01 修订日期：2020-02-20 |
| DOI： |
| 中文关键词: 中文：扩散峰度成像 鼻咽癌 转移性淋巴结 疗效比较研究 |
| 英文关键词:Diffusion Kurtosis Imaging Nasopharyngeal Carcinoma Metastatic Lymph nodes Comparative effectiveness research |
| 基金项目:(编号：2017J01180)、福建省科技计划项目(编号：2018Y2003)、国家临床重点专科建设项目和福建省临床重点专科建设项目共同资助。 |
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| 中文摘要: |
| 目的：探讨扩散峰度成像（DKI）早期评估鼻咽癌颈部转移性淋巴结新辅助化疗疗效。
材料与方法：前瞻性连续入组29例局部中晚期（III-IVa）鼻咽癌初诊患者，于化疗前、开始化疗后第4天、化疗后第1周期末和化疗后第2周期末行包括DKI和DWI的MRI扫描。选取咽后和颈部最短径大于15 mm的转移性淋巴结作为研究对象，采用软件测定DKI参数（MD和MK）和DWI参数（ADC），用RECIST 1.1标准评估新辅助化疗2周期末淋巴结治疗疗效，比较不同疗效组间的DKI及DWI参数差异。
结果：共38枚转移性淋巴结纳入本研究。有效组和无效组之间的化疗后第4天、化疗后第1周期末的多个DKI参数MD值（包括MD4、MD21、ΔMD4和?MD21）的差异具有统计学意义（P＜0.05）；而在比较有效组和无效组之间的ADC值差异时发现：无效组化疗后第4天的ADC值显著低于有效组（P = 0.02）。MD4和ADC4的ROC曲线下面积（AUC）值分别为0.75和0.73。
结论：DKI在预测鼻咽癌颈部转移性淋巴结新辅助化疗疗效中的应用价值或优于传统的DWI技术，本初步结论仍需要进一步验证。 |
| 英文摘要: |
| OBJECTIVE: To investigate the value of Diffusion Kurtosis Imaging (DKI) in early assessing treatment response of metastatic lymph nodes after neoadjuvant chemotherapy (NAC) in nasopharyngeal carcinoma (NPC).
MATERIALS AND METHODS: Twenty-nine subjects who pathologically confirmed with NPC in our institute were enrolled prospectively. All patients scheduled to receive four MRI scans before, on the 4th, 21st, and 42nd days after NAC initiation. Metastatic lymph nodes with a minor-axis diameter larger than 15 mm in retropharyngeal space and jugular vein chain were targeted as observation in our study. The quantitative metrics mean diffusion (MD) and mean kurtosis (MK) derived from diffusion kurtosis imaging (DKI) and apparent diffusion coefficient (ADC) acquired from diffusion weighted imaging (DWI) were analyzed in each time points. The transverse minor-axis diameter of each included lymph nodes at four MRI exam were recorded. All targeted lymph nodes were classified into non-responder group (NRG) and responder group (RG) after two NAC cycles treatment according to the RECIST 1.1. Then we compared the difference of morphological and functional metrics of metastatic lymph nodes before and after NAC treatment between RG and NRG using Student’s t-test or Mann-Whitney U test. Finally the receiver operating characteristics (ROC) curves were analyzed to compare the diagnostic accuracy of DKI and DWI.
RESULTS: A total of 38 lymph nodes were eligible to be evaluated in our study. The MD4, ΔMD4, MD21 and ΔMD21 derived from DKI in RG were statistical significantly larger than those in NRG (all P＜0.05). However, only the ADC4 derived from DWI were proved statistical significantly difference between RG and NRG (P=0.02). There were not any other metrics indicated significant difference between the two groups. The area under ROC curves of MD4 and ADC4 were 0.75 and 0.73 respectively. The diagnostic accuracy of DKI metrics (MD4) was mathematical larger than DWI metric (ADC).
CONCLUSION: Comparing with traditional DWI, DKI may have a potential advantage to early monitor response to NAC of metastatic lymphadenopathies in neck region of NPC and this preliminary still needs to be further validated. |
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