基于体素内非相干性运动的磁共振扩散加权成像评价肺腺癌抗血管生成疗效的研究

抗血管生成治疗已成为晚期非小细胞肺癌最重要的全身治疗手段之一，并已取得较好的疗效，但如何及时、准确地评价疗效及判断预后是亟需解决的难题。本课题拟运用体素内非相干性运动磁共振扩散加权成像（IVIM-DWI）技术评价肺癌抗血管生成疗效，通过与DCE-MRI对照，探讨IVIM-DWI影像生物学标记物真扩散系数D、假扩散系数D*和灌注分数F评价肺腺癌抗血管生成疗效的可行性，阐明治疗前后相关参数变化的组织病理学基础，初步建立IVIM-DWI评价标准；在此基础上通过前瞻性研究比较IVIM-DWI标准评价肺癌抗血管生成治疗和传统化疗疗效的效能差异，进一步验证IVIM-DWI标准评价抗血管生成疗效的临床意义；最后，通过与现行临床评价标准（WHO、RECIST1.1和mRECIST标准）对照，探讨IVIM-DWI影像生物学标记物评价进展期肺腺癌抗血管生成疗效和判断患者预后的重要临床价值。

Antiangiogenic therapy is a new way of treatment for advanced lung cancer. How to promptly and accurately evaluate the efficacy and predict the prognosis is still one of the most important challenges. The objective of this study is to test whether parameters derived from intravoxel incoherent motion diffusion weighted MR imaging (IVIM-DWI) can be evaluated on antiangiogenic therapeutic efficacy in patients with advanced pulmonary adenocarcinoma. Firstly, IVIM-DWI-derived parameters (true diffusion coefficient D, pseudodiffusion coefficient D*, perfusion fraction f ), dynamic contrast-enhanced MRI-derived parameters and pathological changes after antiangiogenic therapy were compared and evaluated the correlation between these quantitative parameters. Secondly, the diagnostic value of IVIM-DWI-derived parameters was evaluated in the quantitative assessment of the antiangiogenic therapeutic and traditional chemotherapeutic efficacy in patient with advanced pulmonary adenocarcinoma. Finally, we also test WHO, RECIST, mRECIST and IVIM-DWI parameter values as surrogate markers of response and correlated with survival after antiangiogenic treatment in patient with advanced pulmonary adenocarcinoma to identify differences in radiologic assessment methods and determine optimal imaging criteria for response evaluation in advanced pulmonary adenocarcinoma patients treated with antiangiogenic inhibitor. Our study might provide early novel imaging biomarkers of tumor response induced by targeted molecular therapy, which are important in determining treatment success, identifying complications, and guiding future therapy.