【摘要】 目的 探究多模态MRI预测中晚期宫颈癌甲磺酸阿帕替尼治疗反应性的临床价值。方法 回顾性选取2017年3月～2022年1月于我院住院的60例接受甲磺酸阿帕替尼治疗的中晚期宫颈癌患者作为研究对象，根据患者治疗反应性将其分为A组（存在显著反应，n=48）和B组（无显著反应，n=12）。收集患者一般资料和多模态MRI检查结果，对两组患者治疗前扩散加权成像、T1WI、T2WI和增强T2*加权血管成像序列扫描后图像中肿瘤信号强度进行比较，采用ROC曲线分析多模态MRI对于接受甲磺酸阿帕替尼治疗的中晚期宫颈癌患者治疗反应性的预测效能。结果 两组患者T1WI序列均以等信号强度为主，T2WI序列均以混杂信号为主，但两组病灶整体信号强度的差异无统计学意义（P>0.05）。两组患者扩散加权成像序列信号强度均以混杂信号为主，幅度图均以低信号为主，相位图和R2*图均以混杂信号为主，其信号强度之间的差异均具有统计学意义（P<0.05）。两组患者表观扩散系数（ADC）值、相位值和R2*值的差异有统计学意义（P<0.05）。ROC曲线显示，ADC值、相位值和R2*值预测宫颈癌患者治疗反应性的曲线下面积分别为0.613、0.656、0.759,R2*值预测效能更高。结论 接受甲磺酸阿帕替尼治疗的中晚期宫颈癌患者治疗后有无反应性在MR常规序列中的征象具有重叠，无特异性，但有反应性患者在扩散加权成像、T2*加权血管成像图像上表现相对于无反应患者更复杂，ADC值、相位值与R2*值可作为判断阿帕替尼治疗后有无反应的定量指标，其中R2*值的价值更高。更多还原

【Abstract】 Objective To evaluate the clinical value of multimodal MRI assessment of the response to apatinib mesylate therapy in advanced cervical cancer. Methods Sixty inpatients with advanced cervical cancer receiving apatinib mesylate therapy in our hospital from March 2017 to January 2022 were retrospectively enrolled. Patients were assigned into group A(complete response, n=48) and group B(partial response, n=12) according to their treatment response. The general data of patients and multimodal MRI findings were collected. Tumor signal intensity on diffusion-weighted imaging, T1WI, T2WI, and enhanced T2 star-weighted angiography scans were compared. Then ROC curve was plotted to assess the predictive efficacy of multimodal MRI for treatment response of advanced cervical cancer patients to apatinib mesylate therapy. Results The lesions of both groups displayed iso-signal intensity on T1WI sequence, and mixed signal intensity on T2WI sequence, with no statistical difference on the overall signal intensity of the lesions between two groups(P>0.05). Lesions appeared as mixed signal intensity on diffusion-weighted imaging sequence in both groups. The amplitude map was all dominated by low signals, and the phase and R2* maps were dominated by mixed signals, with statistical difference in the signal intensity(P<0.05). The apparent diffusion coefficient(ADC), phase value and R2* value demonstrated statistical difference between two groups(P<0.05). ROC curve analysis denoted that the area under the curve of ADC value, phase value and R2* value in predicting the treatment response to apatinib mesylate therapy were 0.613, 0.656 and 0.759. Conclusion The signs in multimodal MRI of advanced cervical cancer patients with and without response to apatinib mesylate therapy have overlap and are non-specific, but patients with response have more complex performance on diffusion-weighted imaging and enhanced T2 star-weighted angiography images compared with non-response patients. ADC values, phase values and R2*values can be used as quantitative indicators to determine the presence or absence of treatment response after apatinib mesylate therapy, among which R2* value is more valuable.更多还原