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目的探讨鼻咽癌化放疗前后动态对比增强磁共振成像(DCE-MRI)定量参数(K~(trans)、K_(ep)及V_e)值的变化情况,从功能学角度评估鼻咽癌化放疗疗效。方法搜集本院2014年10月至2016年1月经病理证实的鼻咽癌初诊患者26例,分别于治疗前和诱导化疗加放疗50 Gy后行常规及DCE-MRI检查,应用后处理软件测量感兴趣区的DCE-MRI定量参数值。采用独立样本t检验,对治疗前肿瘤区和健侧翼外肌的DCE-MRI定量参数进行比较;采用配对样本t检验,对治疗前和诱导化疗加放疗50 Gy后肿瘤区DCE-MRI定量参数进行比较。采用Pearson方法分析治疗前鼻咽癌DCE-MRI各定量参数与诱导化疗加放疗50 Gy后肿瘤消退率的相关性。结果治疗前鼻咽癌肿瘤区的K~(trans)、K_(ep)及V_e值均高于健侧翼外肌,且差异有统计学意义。ROC曲线分析结果显示:在鉴别鼻咽癌肿瘤区与健侧翼外肌时,K~(trans)诊断效能最大。诱导化疗加放疗50 Gy后肿瘤的K~(trans)和K_(ep)值降低,而V_e值升高,且与治疗前的差异均有统计学意义。治疗前K~(trans)、K_(ep)值与肿瘤消退率呈正相关,r值分别为0.544、0.395,治疗前V_e与肿瘤消退率无明显相关性。结论定量DCE-MRI能够从功能学角度量化评估鼻咽癌化放疗疗效,且治疗前的K~(trans)、K_(ep)对预测鼻咽癌对化放疗的敏感性有价值,其中K~(trans)较好。
Objective To investigate the changes of quantitative parameters (K trans, K ep and V e) of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) before and after radiotherapy for nasopharyngeal carcinoma (NPC) Efficacy. Methods Totally 26 newly diagnosed nasopharyngeal carcinoma patients from October 2014 to January 2016 in our hospital were collected and examined by routine and DCE-MRI before and after induction chemotherapy and radiotherapy and 50 Gy respectively. The post-treatment software was used to measure the effect DCE-MRI quantitative parameters of interest area. DCE-MRI quantitative parameters were compared between pre-treatment tumor area and healthy lateralis muscle using independent sample t-test. The paired sample t-test was used to determine the quantitative parameters of DCE-MRI in tumor area before and after induction chemotherapy and induction therapy for 50 Gy Compare The Pearson method was used to analyze the correlation between the quantitative parameters of DCE-MRI and the tumor regression rate after induction chemotherapy and 50 Gy of pre-treatment nasopharyngeal carcinoma. Results The values of K trans, K ep and V e in the tumor area of NPC before treatment were all higher than those of the healthy side, and the difference was statistically significant. The results of ROC curve analysis showed that K trans was the most effective in differentiating nasopharyngeal carcinoma from healthy lateralis. After transcatheter arterial chemotherapies plus radiotherapy and chemotherapy, the K trans and K ep values of the tumors decreased and the values of V e increased. The differences between the two groups were statistically significant. There was a positive correlation between K (ep) and K (ep) values before treatment and tumor regression rate (r = 0.544,0.395, respectively). There was no significant correlation between V_e and tumor regression rate before treatment. Conclusion Quantitative DCE-MRI can quantitatively evaluate the efficacy of radiotherapy for nasopharyngeal carcinoma from the perspective of functional analysis. The trans- and K ep levels before treatment are valuable in predicting the sensitivity of radiotherapy to nasopharyngeal carcinoma. K- (trans) is better.