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目的确定扩散加权和对比剂增强MR成像上容积改变是否有助于评估神经内分泌性肝转移瘤(NELM)对动脉内介入疗法(IAT)的早期肿瘤反应。材料与方法这一回顾性单中心影像分析符合HIPAA规定,经机构伦理委员会通过,免除病人的知情同意。回顾性分析71例(39例男性,平均年龄62.3岁)患NELM行IAT治疗的病人。在治疗前和治疗后3~4周行MRI检查。对入围病灶进行分段以提供针对表观扩散系数(ADC)和肝动脉期(HAP)及门静脉期(PVP)增强MR成像的容积功能分析。肿瘤反应定义为容积ADC增加≥15%,同时容积增强在HAP期降低≥25%或PVP期降低≥50%。病人总生存期按治疗开始后的初始结点算起。单变量分析包括Kaplan-Meier生存曲线。Cox比例风险回归模型用于检测容积ADC和对比增强MR成像间的交互作用并计算风险比。结果全部病人平均容积ADC显著增加(27%,P<0.0001),平均容积增强在HAP期间(-25.3%,P<0.0001)和PVP期间(-22.4%,P<0.0001)显著减少。容积ADC增加≥15%的病人(n=49)较容积ADC增加<15%者的治疗后预后(n=22)要好(对数秩检验;;P<0.002)。容积动脉期增强减少≥25%的病人(n=40)或静脉期增强减少≥50%的病人(n=18)预后较动脉期增强减少<25%(n=31)和静脉期减少<50%者(n=53)为好(对数秩检验;;P<0.02)。结论容积功能MR成像准则可作为早期反应的生物标志物;;提示这些准则可能对将来复杂的NELM临床实验很重要。
Objectives To determine whether diffusion-weighted and contrast-enhanced volume changes in MR imaging help to assess the early tumor response of neuroendocrine liver metastases (NELM) to intra-arterial interventional therapy (IAT). Materials and Methods This retrospective, single-center image analysis was in accordance with HIPAA regulations and was approved by the Institutional Ethics Committee to dispense patient informed consent. Retrospective analysis of 71 patients (39 males, mean age 62.3 years) suffering from NELM IAT treatment of patients. MRI examination was performed before treatment and 3 to 4 weeks after treatment. Focal lesion was segmented to provide volumetric functional analysis of enhanced MR imaging for apparent diffusion coefficient (ADC) and hepatic artery phase (HAP) and portal vein phase (PVP). Tumor response was defined as a ≥ 15% increase in volume ADC with a volume increase ≥25% reduction in HAP or ≥50% reduction in PVP. The patient’s overall survival was calculated as the initial node after the treatment started. Univariate analysis included Kaplan-Meier survival curves. The Cox proportional hazards regression model was used to detect the interaction between the volumetric ADC and contrast-enhanced MR imaging and to calculate the hazard ratio. Results The mean volume ADC was significantly increased in all patients (27%, P <0.0001). The mean volume enhancement was significantly decreased during HAP (-25.3%, P <0.0001) and PVP (-22.4%, P <0.0001). Patients who had a ≥15% increase in volume ADC (n = 49) had a better outcome (n = 22) than a rise in volume ADC of <15% (log rank test ;; P <0.002). Patients with nadir enhancement ≥25% (n = 40) or nodules ≥50% (n = 18) showed a <25% (n = 31) % (N = 53) was good (log rank test ;; P <0.02). Conclusions Volumetric functional MR imaging criteria can serve as biomarkers of early response; suggesting that these guidelines may be important for future complex NELM clinical trials.