目的：探讨MRI纹理分析评价直肠癌新辅助放化疗疗效的价值。方法：回顾性分析58例确诊为直肠癌并行新辅助放化疗，随后行直肠癌全系膜切除术的患者的资料。依据Dworak肿瘤退缩分级标准将手术标本分为完全缓解组和非完全缓解组。依据3.0T MRI AX T2序列图像勾画感兴趣区，自动计算标准差、偏度、峰度、均匀性、能量和熵等纹理参数，对参数进行统计学分析。结果：完全缓解组16例，非完全缓解组42例。Wilcoxon符号秩和检验比较新辅助放化疗前、后两组间熵的差异具有统计学意义（P<0.05），Mann-Whitney U检验得出完全缓解组和非完全缓解组间标准差、均匀性、能量和熵的差异有统计学意义（P<0.05），其余参数间差异无统计学意义（P>0.05）。ROC曲线分析显示治疗前标准差、均匀性、能量、熵及治疗后能量、熵的曲线下面积（AUC）分别是0.769、0.805、0.807、0.685、0.893、0.899。Spearman检验得出完全缓解与能量、均匀性呈正相关，与标准差、熵呈负相关。结论：MRI纹理分析参数具有预测直肠癌新辅助放化疗疗效的价值。
Abstract
Objective: To explore the efficacy predicting value of pretreatment MRI texture analysis(TA) in patients with rectal cancer receiving neoadjuvant chemoradiotherapy(nCRT). Methods: Fifty-eight patients who received nCRT, followed by total mesorectal excision(TME) surgery for advanced rectal cancer were included. Dworak tumour regression grade(TRG) method was used to assess treatment response, patients were divided into complete response group(pCR, TRG 4) and non-pCR group(TRG 0~3). TA parameters were measured based on the AX T2 propeller sequence of MRI, including standard deviation, skewness, kurtosis, uniformity, energy, and entropy. Statistical analysis was performed on these parameters. Results: Sixteen pCR and 42 non-pCR patients were evaluated. The Wilcoxon rank sum test showed that the difference between pre-entropy and after-entropy in two groups has significant difference(P<0.05). The Mann-Whitney U test showed significant differences between pCR and non-pCR groups in standard deviation, uniformity, energy and entropy(P<0.05), and the others have no significant difference(P>0.05). For pre-standard deviation, pre-entropy, pre-energy, pre-uniformity, after-energy and after-entropy, the ROC analysis showed an area under the curve(AUC) of 0.769, 0.805, 0.807, 0.685, 0.893 and 0.899, respectively. The Spearman test showed that the response to treatment was positively correlated with energy and uniformity, and negatively correlated with standard deviation and entropy. Conclusion: The MRI TA of recal cancer has the predicting value on treatment response.
关键词
直肠肿瘤 /
治疗结果 /
磁共振成像
Key words
Rectal neoplasms /
Treatment outcome /
Magnetic resonance imaging
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