| Part ⅠThe valve of diffusion-weighted imging on preticting concurrent chemoradiotherapy response of patients with advanced non-small cell lung cancer[Purpose]:To investigate the capability of diffusion-weighted imging (DWI) on 3.0T MRI to predict response to concurrent chemoradiotherapy (CCRT) in patients with advanced non-small cell lung cancer (NSCLC).[Materials and Methods]:37 patients with stage III NSCLC underwent DWI on 3.0T MRI before CCRT were enrolled. Additionally, some of these patients were underwent DWI at 2 weeks after starting therapy (total dose of 20 Gy), and (or) at the end of therapy (total dose of 60 Gy). The quantity of diffusion-weighted imgings were evaluated on 3-level grades as good, moderate and failed. Apparent diffusion coefficient (ADC) of lung cancer which were grade as good and moderate were calculated by Funtool. The following quantitative parameters were recorded and calculated:the mean pretreatment ADC value (ADCpre), the mean mid-treatment ADC value (ADCmid), the mean post-treatment ADC value (ADCpost), the rate of changes of mean ADC value at 2 weeks post starting therapy (Δ ADCmid) and the rate of changes of mean ADC value at the end of therapy (Δ ADCpost). The patients were classified into respond group and non-respond group according to the tumor response, which was assessed with revised response evaluation criteria in solid tumors (RECIST1.1) after CCRT. The relationship between these obtained parameters and tumor response was evaluated by Spearson’s correlation analysis. The value of parameters on predicting responders were calculated by receiver operating characteristic curve (ROC).[Result]:Among 37 patients, the DW images of 34 patients (91.9%) were graded as good or moderate. Of 34 patients,22 patients were underwent DWI two times (pre-treatment, at 2 weeks post starting therapy),16 patients were underwent DWI three times (pre-treatment, at 2 weeks after starting therapy, post-treatment). Tumor regression rate after treatment had negative correlation with ADCpre (r=-0.456, P=0.007), and had positive correlation with ADCmid, ADCpost, Δ ADCmid, A ADCpost (r=0.458-0.667, P <0.05). The responders had lower ADCpre[(1.31±0.26) ×10-3 mm2/s vs. (1.59±0.23) × 10-3 mm2/s, P=0.001], higher ADCpost[(2.12±0.26) × 10-3 mm2/s vs. (1.70±0.45) ×10-3 mm2/s, P=0.032], and increased ADC (ΔADCmid:28.1%±14.4% vs.6.2%± 20.3%, P=0.008) in mid-treatment than non-responders. ROC indicated when setting threshold on pretreatment ADCpre=1.35 ×10-3 mm2/s, AADCmid=23.2%, ADCpost =1.89 × 10-3 mm2/s, the area under curve was 0.837,0.792, and 0.800.[Conclusion]:The mean ADC value before/or after CCRT and its changes during CCRT is likely to be a viable tool for predicting the response after CCRT of advanced NSCLC, which would to be helpful to clinical decision on individualized therapy.Part ⅡThe valve of intravoxel incoherent motion diffusion weighted imaging on preticting concurrent chemoradiotherapy response of patients with advanced non-small cell lung Cancer[Purpose]:To investigate the capability of intravoxel incoherent motion diffusion weighted imaging (IVIM-DWI) on 3.0T MRI to predict response to concurrent chemoradiotherapy (CCRT) in patients with advanced non-small cell lung cancer (NSCLC).[Materials and Methods]:27 patients with stage Ⅲ NSCLC underwent DWI on 3.0T MRI before CCRT were enrolled. The quantity of intravoxel incoherent motion diffusion-weighted imgings were evaluated on 3-level grades as good, moderate and failed. The IVIM-DWI parameters of lung cancer which were grade as good and moderate were calculated by Funtool. Two group parameters were recorded and calculated:the standard ADC value (ADCstandard) which was calculated by mono-exponential model; the slow ADC value (ADCslow), the fast ADC vlue (ADCfast) and the fraction of fast ADC (f) which was calculated by bi-exponential model. The patients were classified into respond group and non-respond group according to the tumor response, which was assessed with revised response evaluation criteria in solid tumors (RECIST1.1) after treatment. The relationship between these obtained parameters and tumor response was evaluated by Spearson’s correlation analysis. The value of parameters on predicting responders were calculated by receiver operating characteristic curve (ROC).[Result]:All IVIM-DW images were graded as good or moderate. The ADCstandard was markedly higher than ADCslow [(1.37±0.19) ×10-3 mm2/s vs. (1.08±0.22) ×10-3 mm2/s, P=0.000]. Tumor regression rate after treatment had negative correlated with (r=-0.777, P=0.000). ROC indicated when setting threshold on pretreatment ADCslow=1.03 × 10-3 mm2/s, ADCstandard=1.41×10-3 mm2/s, the area under curve was 0.951,0.728.[Conclusion]:Intravoxel incoherent motion (IVIM) imaging enables the separate assessment of diffusion-related and perfusion parameters by bi-exponential model. IVIM-derived diffusion-related parameter, which seemed to be more meaningful than the standard ADC value calculated by mono-exponential model, was demonstrated to predict therapeutic effect after CCRT of advanced NSCLC, and maybe a new direction of study in evaluating lung cancer response to treatment in the future.Part ⅢThe valve of quantiative dynamic contrast enhanced MRI on preticting concurrent chemoradiotherapy response of patients with advanced non-small cell lung Cancer[Purpose]:To investigate the capability of using DCE-MRI quantitative parameters to predict response to concurrent chemoradiotherapy (CCRT) in patients with advanced non-small cell lung cancer (NSCLC).[Materials and Methods]:28 patients with stage Ⅲ NSCLC, who underwent DCE-MRI before CCRT and 2 weeks after starting therapy (total dose of 20 Gy), were enrolled. And 18 of these patients underwent DCE-MRI at the end of therapy (total dose of 60 Gy) additionally. Quantitative parameters (Ktrans, Kep, Ve, Vp) were calculated by Omnikinetics software. The following quantitative parameters were recorded and calculated:pretreatment parameters, mid-treatment parameters, post-treatment parameters, the changing rate of quantitative parameters at 2 weeks after starting therapy and the rate of changes of quantitative parameters at the end of therapy. The patients were classified into respond group and non-respond group according to the tumor response, which was assessed with revised response evaluation criteria in solid tumors (RECIST1.1) after treatment. The relationship between these obtained parameters and tumor response was evaluated by Spearmen’s correlation analysis. The value of parameters on predicting responders were calculated by receiver operating characteristic curve (ROC).[Result]:Tumor regression rate after treatment had negative correlation with pretreatment Ve (r=-0.545, P=0.003), post-treatment Ktrans (r=-0.548, P=0.019), Δ post-treatment Ktrans (r=-0.626, P=0.005), Δ post-treatment Kep (r=-0.476, P=0.046), and had positive correlation with Δmid-treatment Ve (r=0.687, P=0.000). Patients with higher pre-treatment Ktrans and Kep, lower pre-treatment Ve and increased Ve in mid-treatment tended to have a good response (P<0.05). The respond group had a markedly decreased pre-treatment Ktrans and Kep at the end of therapy than non-respond group (P<0.05). ROC indicated when setting threshold on pretreatment Ktrans=0.37 min-1, pretreatment Kep=1.52 min-1, pretreatment Ve=0.24, A mid-treatment Ve=15.4%, Δ post-treatment Ktrans=-9.8%, Δ post-treatment Kep=-20.1%, the area under curve was 0.727,0.775,0.888,0.882,0.844,0.857, respectively.[Conclusion]:DCE-MRI derived quantitative parameters and those changes during treatment seems to be a viable tool for predicting the response after CCRT of NSCLC, which would to be helpful in clinical decision in individualized therapy. |
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