The Clinical Study Of Using Diffusion-Weighted Magnetic Resonance Imaging (Dwi) To Predict Therapeutic Effect (Te) Of Esophageal Primary Tumor Treatment With Chemoradiation Therapy

To investigate the diagnostic efficiency of DWI parameters in early predicting TE of esophageal carcinoma treatment with chemoradiation therapy (CRT), find the optimized predicting time point and predicting threshold. From June 2010 to October 2011, 38 patients were prospectively enrolled into a cohort study, the prescription dose was 60 Gy/30f/6w, chemotherapy of FP, or TP was given concurrently or consolidatedly. DWI was performed at the beginning and the 1st, 2nd, 3rd, 4th, 5th, 6th weekend of the course of treatment, ADC values and lesion lengths in DWI sequence were recorded and analyzed. The immediate post-CRT TE was evaluated according to RECIST. After completion of CRT, 20 (52.6%) and 18 (47.4%) patients were determined as showing CR and PR, respectively. The ADC values (×10-3mm2/s) of pre-CRT and the 1st to 6th weekend for the two groups were 1.82±0.50, 1.92±0.55, 2.06±0.55, 2.35±0.55, 2.62±0.50, 2.71±0.57, 2.96±0.62 and 1.42±0.30, 1.49±0.21, 1.67±0.30, 1.79±0.32, 2.11±0.44, 2.18±0.44, 2.28±0.52, respectively. The ADC values of CR group were higher than that of PR group at the 7 monitoring points, P<0.05, but ADC change rate(ΔADC) of two groups were similar, P>0.05. The results of repeated measurement variance analysis and mutivariance analysis indicated that there were significant difference among the ADC values at different time points, furthermore, the ADC values of two groups at each time were significantly different, the same were the results of lesion lengths in DWI. (2) Results of Logistic regression analysis manifested that only ADC values at the end of 3rd week was independent prognostic factor of tumor response (OR = 0.134, P = 0.007), further analysis of ROC curves also indicated that the ADC values of the 3rd weekend was the optimized parameter (AUC = 0.857), the threshold was 2.02×10-3mm2/s, with corresponding sensitivity of 80.00% and specificity of 92.86%. (3) The ADC curve of recurrence group (tumor recurred in 1 year) ascended from the beginning to the 4th week, but dropped to the bottom of control group at the monitoring point of 5thweek. DWI examination could afford useful markers to predict TE of esophageal cancers in early time, the ADC values of the 3rd weekend maybe the optimized predicting time point, the phenomenon of ADC value dropped in late treatment course indicated a high tendency of tumor recurrence.