The Value Of IVIM-DWI In Evaluating The Efficacy Of Concurrent Chemoradiotherapy In Advanced Non-small Cell Lung Cancer

Objective:There is a certain lag in evaluating the efficacy of non-surgical treatment of lung cancer by structural and morphological changes.Intravoxel incoherent motion-diffusion weighted imaging(IVIM-DWI)can provide functional information during tumor treatment,which may be helpful for early efficacy evaluation.In this study,IVIM-DWI during concurrent chemoradiotherapy of advanced non-small cell lung cancer(NSCLC)was analyzed to explore whether relevant functional parameters can be used as potential imaging biomarkers for early efficacy evaluation of lung cancer treatment.Methods:This prospective study included 21 patients with advanced NSCLC who were admitted to Shanxi Bethune Hospital from April 2021 to August 2022 and were confirmed to receive concurrent chemoradiotherapy.Conventional MRI plain scan,DWI scan and IVIM scan were performed before and after treatment.ADC value,IVIM true diffusion parameter(D),pseudo diffusion parameter(D*)and perfusion fraction(f)were recorded before and after treatment.About 2-3 months after treatment,the patients were divided into effective group and ineffective group according to RECIST 1.1 standard.Intraclass correlation coefficient(ICC)was used to evaluate inter-observer agreement and measurement repeatability.The differences of parameters and parameter change rates between the effective group and the ineffective group before and after concurrent chemoradiotherapy were compared by t test.ROC curve was used to analyze the results with statistical differences,and to find the best parameters and thresholds for early prediction of NSCLC concurrent chemoradiotherapy.Results:After clinical and radiological evaluation,there were 9 cases in the effective group and 12 cases in the ineffective group.The repeatability of D * value after treatment was general.The repeatability of ADC value,D value,f value and D * value before treatment was good in the effective group and the ineffective group before and after treatment.There was no significant difference in ADC value,D value,D * value and f value between the effective group and the ineffective group before concurrent chemoradiotherapy.After concurrent chemoradiotherapy,the ADC value,D value and f value of the effective group were significantly higher than those before treatment,and the differences were statistically significant(P < 0.05).The ADC value,D value and f value of the ineffective group after concurrent chemoradiotherapy were not significantly different from those before treatment.After concurrent chemoradiotherapy,the changes of △ % ADC and △ % D in the effective group were significantly different from those in the ineffective group(P < 0.05),and the changes of △% f and △% D* were not significantly different from those in the ineffective group.ROC analysis showed that △% D was the best factor for evaluating and predicting the efficacy of concurrent chemoradiotherapy in advanced NSCLC,with an area under curve(AUC)of 0.870.Conclusion:IVIM-DWI parameters have a potential role in evaluating and predicting the efficacy of concurrent chemoradiotherapy for advanced non-small cell lung cancer in the early stage of treatment,and the change rate of D value before and after treatment has the best predictive effect.