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目的探讨MR扩散加权成像(diffusion-weighted imaging,DWI)在预测、监测直肠癌放、化疗效果中的应用价值。资料与方法动态监测15例行放、化疗的直肠癌患者,于放化疗前、放化疗结束和放化疗后4~5周行3次常规MRI及DWI。测量直肠癌的长度、肿瘤侵犯直肠壁厚度和表观扩散系数(apparent diffusion coefficient,ADC)值在放化疗前、后各时间点的变化,并分别进行比较;依据实体瘤疗效评价标准(RECIST)分组,比较各组在放化疗前ADC值之间的差异。结果直肠癌放化疗结束时,肿瘤侵犯肠壁的厚度较放化疗前差异有统计学意义(0.010.05);而对于放化疗结束与放化疗后4~5周,三者的变化差异均无统计学意义。放化疗前部分缓解(PR)与病灶稳定(SD)组之间的ADC值差异无统计学意义(P=0.222>0.05)。结论 DWI可优先、准确评价直肠癌放化疗的疗效相对于肿瘤形态学变化;而放化疗前ADC值对于预测直肠癌放化疗的疗效无明显意义。
Objective To investigate the value of MR diffusion-weighted imaging (DWI) in the prediction and monitoring of radiotherapy and chemotherapy in rectal cancer. Materials and Methods Fifteen patients with rectal cancer undergoing radiotherapy and chemotherapy were dynamically monitored. The conventional MRI and DWI were performed before radiotherapy and chemotherapy, after radiotherapy and chemotherapy and 4-5 weeks after radiotherapy and chemotherapy. The length of rectal cancer, the thickness of rectal wall and the apparent diffusion coefficient (ADC) value of tumor before and after chemoradiotherapy were measured and compared at different time points. According to the criteria of RECIST, Grouping, comparing the differences in ADC values between groups before radiotherapy and chemotherapy. Results At the end of radiotherapy and chemotherapy of rectal cancer, the thickness of the tumor invasion wall was significantly different from that before radiotherapy and chemotherapy (0.01
0.05). However, there was no significant difference between the end of radiotherapy and chemotherapy and 4 to 5 weeks after radiotherapy and chemotherapy. There was no significant difference in ADC value between PR and SD group before radiotherapy and chemotherapy (P = 0.222> 0.05). Conclusions DWI can evaluate the curative effect of radiotherapy and chemotherapy of rectal cancer relative to tumor morphology preferentially and accurately. However, the value of ADC before radiotherapy and chemotherapy is not significant for predicting radiotherapy and chemotherapy of rectal cancer.