【摘要】 目的探讨动态对比增强磁共振成像（dynamic contrast-enhanced magnetic resonance imaging,DCE-MRI）参数对喉癌术后放疗短期预后的评估价值。方法 本研究采用病例-对照研究设计方案，选取浙江省湖州市中心医院放射科2021年1月至2023年12月收治的127例喉癌患者为研究对象，患者接受不同肿瘤处理方式后进行根治性放疗。根据患者术后放疗肿瘤是否复发分为复发组（50例）和未复发组（77例），比较2组患者DCE-MRI参数[容量转移常数（volume transfer constant,Ktrans）、速率常数（rateconstant,Kep）、细胞外血管外间隙容积比（volumefractionofextracellular extravascular space,Ve）]及临床资料，采用多因素Logistic回归模型分析喉癌患者术后放疗短期预后的影响因素。采用受试者工作特征（receiver operating characteristic,ROC）及其曲线下面积（area under the curve,AUC）评估DCE-MRI参数对喉癌患者术后放疗短期预后的预测效能。结果 复发组患者手术切缘阳性、术前病灶最大径≥4 cm、溃疡型病灶、N分期为N1～N3期、分期为晚期（Ⅲ、Ⅳ）占比均高于未复发组（P<0.05）；复发组的Ktrans、Kep高于未复发组，Ve低于未复发组（P<0.05）；多因素Logistic回归分析显示，手术切缘为阳性、N分期为N1～N3期、Ktrans、Kep是喉癌术后放疗短期预后的独立危险因素，Ve是保护因素（P<0.05）;ROC结果显示，Ktrans、Kep、Ve三参数联合应用和五指标联合应用的Logistic回归模型诊断喉癌术后放疗短期预后的AUC(95%CI)分别为0.920(0.858～0.961)、0.923(0.862～0.963)，三参数联合应用较单独应用的AUC明显提高（P<0.05），与五指标联合应用的AUC比较无差异。结论 DCE-MRI参数Ktrans、Kep、Ve与喉癌术后放疗短期预后密切相关，Ktrans、Kep、Ve联合对喉癌患者术后放疗短期预后具有较好的预测效能。更多还原

【Abstract】 Objective To investigate the value of dynamic contrast-enhanced magnetic resonance imaging(DCE-MRI) parameters in evaluating the short-term prognosis of laryngeal cancer patients after postoperative radiotherapy. Methods A case-control study was performed on 127 laryngeal cancer patients admitted to our hospital from January 2021 to December 2023. The patients underwent different tumor treatment followed by radical radiotherapy. According to tumor recurrence or not, they were divided into a recurrence group(n=50) and a non-recurrence group(n=77). DCE-MRI parameters, such as volume transfer constant(Ktrans), rate constant(Kep), and volume fraction of extracellular extravascular space(Ve), and clinical data were compared between the 2 groups. Multivariate logistic regression analysis was used to identify influencing factors for short-term prognosis after radiotherapy. Receiver operating characteristic(ROC) curves were plotted to evaluate the predictive efficacy of DCE-MRI parameters, and the area under the curve(AUC) was calculated. Results The recurrence group had significantly larger proportions of positive surgical margins, preoperative maximum lesion diameter ≥4 cm, ulcerative lesions, stages N1～N3, and advanced stages Ⅲ ～ Ⅳ, and obviously higher Ktrans and Kep values but lower Ve valus than the nonrecurrence group(P<0. 05). Multivariate logistic regression analysis indicated that positive surgical margins,stages N1～N3, Ktrans, and Kep were independent risk factors for short-term prognosis, while Ve was a protective factor(P<0. 05). ROC curve analysis showed that the AUC value of combination of Ktrans, Kep and Ve and of above 5 indicators in predicting short-term prognosis of postoperative radiotherapy for laryngeal cancer was 0. 920(95%CI: 0. 858～0. 961) and 0. 923(95%CI: 0. 862～0. 963), respectively. Though the AUC value of combined 3 parameters was significantly higher than that of the single indicator alone(P<0. 05), there was no difference in the value between the combination of 3 parameters and the combined application of the 5indicators. Conclusion DCE-MRI parameters Ktrans, Kep, and Ve are closely associated with short-term prognosis of postoperative radiotherapy for laryngeal cancer. Their combination has a good predictive efficacy for the short-term prognosis of the patients.更多还原