| Objective 1.Use different diffusion sensitivity coefficient(b value)to scan the lung cancer focus with diffusion-weighted imaging sequence,and to select the optimal b value according to the information of the focus and surrounding normal lung tissue.2.To explore the early evaluation of the effect of diffusion-weighted imaging on lung cancer treated by the combination of traditional Chinese and Western medicine according to the change rule of the mass length and ADC value before and after the treatment of lung cancer efficacy,easy to guide clinical.Materials and methods 1.Study subjects:40 patients(including outpatients and inpat ients)in the Third Affiliated Hospital of Beijing University of traditional Chinese medicine were selected as the study object after pathological diagnosis or imaging diagnosis.After preliminary imaging examination,42 lesions were found to meet the measurement conditions,including 13 full adenocarcinoma,26 squamous carcinoma and small ones Cell carcinoma(3 cases).2.Method:All the patients were scanned at three time points before treatment,one week after treatment and three months after treatment.The MRI sequence included conventional transverse position T1WI,transverse position T3wI and transection fat supression T2WI and multi-b-vaIue DWI(b-valuc Os/mm2,400s/mm2,700s/mm2,1000s/mm2,respectively)were examined.The scanning range was from the chest entrance to bilateral adrenals(including the whole adrenals).The patie nt’s body position and scan sequence parameters should be consistent at each follow-up time point.After the patient completes the examination,all the original images collected each time will be sent back to Philips workstation,and then the lesions will be measured and analyzed with the image post-processing software provided by the equipment,and the ADC image will be generated.After comparing the T1WI and T2WI images,the location of lung cancer lesions and the surroundingg normal lung tissues were determined.The region of interest(ROI)and the signal intensity(SI)and background noise standard deviation(SD background)of the corresponding location were measured.3.Statistical analysis:Take the average value after multiple measurements.Through statistical analysis and comparison of signal to noise ratio(SNR)and contrast to noise ratio(CNR)of DWI images under different b-values,the best b-value was selected for the examination.After three months’ treatment with radiotherapy,chemotherapy and traditional Chinese medicine,all patients meeting the measurement requirements were divided into groups.The length of the follow-up focus was measured on the T1WI and T2WI images obtained from the last scan,and compared with the length of the focus before treatment.According to the international recommended response evaluation criteria in solid tumors(RECIST 1.1)to evaluate the comprehensive effect of the mass after two cycles of treatment.A total of 43 lesions were measured and analyzed.According to the evaluation value,they were divided into complete response(CR)which showed that the lung cancer lesions were basically absorbed and disappeared,partial respon se(PR)which showed that the lung cancer lesions were reduced by 30%,stable disease(SD)showed that the reduction of lung cancer focus was less than 30% and the in crease was less than 20%,and(PD)showed that the increase of lung mass was up to 20%.Among them,the number of complete and partial remission cases were classified as the effective group,the number of stable and progressive cases were classified as the ineffective group.Finally,34 lesions in the effective group were counted,There were 8 lesions in the ineffective group.The paired sample t-test was used to analyze whether there were statistical differences in the maximum diameter and average ADC value of all lesions before and after treatment;the average ADC value of the masses before treatment,the maximum diameter of the masses before treatment and the change rate of the ADC value after treatment in the effective group and the ineffective group[△△DC%(△DCafter-△DCbefore)/△DCbeforet×100%]and maximum dianieter change rate[AD%=(Dather-Dbefore)/Dbefore×100%]has statistical significance is analyzed by independ ent sample t-test;ADC value,maximum diameter value of tumor and average focus value after one cycle of Integrated Chinese and Western medicine treatment are analyzed by ROC curve ADC value change rate and the maximum diameter change rate of the focus,to determine whether there is diagnostic efficacy of each value,and determine the best threshold.All the data were analyzed by SPSS 21.0.WhenP≤0.05,the difference was statistically significant.All measurement data are expressed as mean ± standard deviation(X±s).Results 1.SNR value of lesions:the highest value was 73.5± 12.7 when the b value was 400s/mm2;the lowest value was 65.25± 15.44 when the b value was 700s/mm2;the lowest value was 51.35± 11.16 when the b value was 1000s/mm2;there was statistical difference between the b value of 400s/mm2 and 700s/mm2and the b value of 1000s/mm2.2.CNR value of focus lung tissue:when the b value is 700s/mm2,the CNR value is the highest,70.56± 12.66;when the b value is 400s/mm2,the SNR value is 62.86± 14.97;while when the b value is 1000 s/mm2,the SNR value is the lowest,49.31±11.45;the results of statistical analysis show that the CNR value of focus lung tis sue is statistically different from that of B value at 400s/mm2 and 700s/mm2.3.ADC value of lesions under different b values:when b value is 400s/mm2,the average AD C value of lesions is the largest,which is(1.54±0.13)x10-3mm2/s,but the fluctuation range of ADC value is the largest;when b value is 700s/mm2,the average ADC value of lesions is(1.45±0.1)x10-3mm2/s,but the fluctuation range of ADC value is the smallest and the most stable;when b value is 1000s/mm12,the average ADC value of les ions is(1.32±0.11)x10-3mm2/s.There was no significant difference in ADC value between different b values.4.Analysis of the average ADC value and the changes before a nd after long-distance treatment of lung cancer:42 lung cancer lesions were detected.After one cycle of radiotherapy and chemotherapy combined with traditional Chinese medicine,the average ADC value of the lesions was(1.6±0.13)x10-3mm2/s,significantl y higher than that before treatment(1.45±0.1)x10-3 mm2/s,and the difference was significant(P=0.000);After treatment,the length and diameter of the lesions were(41.86± 11.5),slightly smaller than that before treatment(42.66± 11.66).After analysis,there was no significant difference(P=0.055).5.Statistical analysis of the effective group and the ineffective group on the corresponding long diameter before treatment,the average ADC value before treatment the ADC value change rate after one cycle after treatment and the long diameter change rate of mass:34 lesions in the effective group and 8 lesions in the ineffective group.The statistical analysis shows that the average ADC value change rate after one cycle of treatment in the effective group is(12.3±4.19)x10-3 mm2/s.The difference was statistically significant(P=0.000).but there was no significant difference in the other three groups(P>0.05).6.Evaluation of the diagnostic efficacy of ADC value,ADC value change rate,long diameter value and long diameter change rate of lung cancer focus after treatment:all cases were analyzed and evaluated with the working characteristic curve of subjects after one cycle of treatment.Results after treatment,ADC value and ADC value change rate had diagnostic efficacy on the curative effect of combination of Chinese and Western Medicine(P<0.05)The area under the curve of ADC value change rate is the largest,AUC=0.814,and the evaluation efficiency is the best.When the change rate of ADC value was 8.4%,the sensitivity and specificity of efficacy evaluation were 79.4%and 75%respectively.Conclusion 1.When the b-value of mass weighted MR imaging is 700s/mm2,the SNR and CNR of the focus lung tissue are the best.At this time,the DWI image is clearer than the other b-values,and the fluctuation range of ADC value is also consid ered.Therefore,the measurement stability is better than the other b-values,which can provide more comprehensive and accurate quantitative information for diagnosis.2.There is no statistical difference in the length before treatment,ADC value before treatment,length after treatment and its change rate,which can not effectively evaluate and predict the curative effect in the early stage of treatment.However,the average ADC value and ADC value change rate after treatment are significantly higher than before treatment,and the difference is statistically significant,which indicates that it can be used in the early stage of treatment of lung cancer with integrated traditional Chinese and Western medicine Reflect the therapeutic effect,as an index to evaluate the therapeutic effect.3.The area under the ADC value change rate curve of lung cancer focus is the largest,AUC=0.814,which has higher diagnostic efficiency than the average ADC value,and is more suitable for clinical guidance.When the change rate of ADC value was 8.4%,the sensitivity and specificity of efficacy evaluation were 79.4% and 75% respectively. |
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