诊断学理论与实践2025，Vol.24Issue(2)：170-177,8.DOI:10.16150/j.1671-2870.2025.02.008
合成磁共振预测局部进展期直肠癌患者行新辅助放化疗疗效的价值
Value of synthetic MRI in predicting treatment response to neoadjuvant chemoradiotherapy in patients with locally advanced rectal cancer
摘要
Abstract
Objective To explore the effectiveness of synthetic MRI sequences in predicting the treatment response of patients with locally advanced rectal cancer(LARC)undergoing neoadjuvant chemoradiotherapy treatment(nCRT).Methods A total of 51 patients with biopsy-confirmed rectal adenocarcinoma were enrolled at Ruijin Hospital from August 2023 to June 2024.All patients were assessed as having LARC by baseline MRI and received nCRT followed by radical surgery.All subjects completed synthetic MRI and high-resolution T2-weighted imaging(T2WI)scans within two weeks before receiving nCRT treatment.Based on high-resolution T2WI images,radiologists assessed extramural vascular inva-sion(mrEMVI)at baseline in the subjects.After the synthetic MRI sequence scanning was completed,synthetic images of T1 mapping,T2 mapping,and proton density(PD)mapping were generated using Synthetic MR post-processing software.Histogram-based quantitative parameters at baseline were extracted using python software,including quantitative parame-ters of the primary tumor and peritumoral fat region:T1 relaxation time(T1RT),T2 relaxation time(T2RT),and proton den-sity(PD).Using postoperative pathological results as the gold standard,patients were grouped according to:(1)primary tumor response:pathological complete response(pCR)vs.non-pCR;(2)tumor regression grade:(TRG)0-1 vs.TRG 2-3;and(3)mesorectal lymph node metastasis status:positive(ypN+)vs.negative(ypN-).Differences in baseline mrEMVI status and quantitative parameters of the primary tumor and peritumoral fat among different groups were compared using Student's t-test,Mann-Whitney U test,and Chi-square test.Binary logistic regression was used to identify independent risk factors for predicting TRG grade,pCR status,and mesorectal lymph node status.Based on the selected risk factors,logistic regression models were established.The predictive performance of the quantitative parameters,mrEMVI status,and the regression models for TRG grade,pCR status,and mesorectal lymph node status was evaluated using receiver operating characteristic(ROC)curves.Results Baseline mrEMVI positivity(P=0.03)and quantitative parameters of peritumoral fat tissue-including the maximum T2RT_Fat(139.53 ms vs.129.60 ms,P=0.03),90th percentile(189.18 ms vs.174.00 ms,P=0.03),root mean square(120.09 ms vs.115.48 ms,P=0.04),and lower T2RT_Fat uniformity(0.54 vs.0.61,P=0.04)—were indicative of positive mesorectal lymph node status after nCRT.None of the observed indicators were correlated with the pri-mary tumor response.Logistic regression analysis showed that mrEMVI and elevated T2RT_Fat_P90 were independent risk factors for predicting mesorectal lymph node metastasis.The logistic regression model combining both mrEMVI(AUC=0.667)and T2RT_Fat_P90(AUC=0.692)demonstrated good predictive performance(AUC=0.747),although the improve-ment was not statistically significant.Conclusions T2RT_Fat_P90,extracted from baseline MAGiC synthetic MRI serves as a non-invasive imaging biomarker for predicting mesorectal lymph node metastasis after nCRT.The combination of T2RT_Fat_P90 and baseline mrEMVI can be used as an auxiliary tool for predicting the mesorectal lymph node metastasis status in LARC patients following nCRT.关键词
直肠癌/淋巴结转移/磁共振成像/新辅助放化疗Key words
Rectal cancer/Lymph node metastasis/Magnetic resonance imaging/Neoadjuvant chemoradiotherapy分类
医药卫生引用本文复制引用
王康宁,朱兰,冯威铭,夏益涵,石博文,张欢..合成磁共振预测局部进展期直肠癌患者行新辅助放化疗疗效的价值[J].诊断学理论与实践,2025,24(2):170-177,8.基金项目
国家自然科学基金(82101986 （）
82271934) （）
