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综   述｜｜Reviews                       磁共振成像  2024年7月第15卷第7期  Chin J Magn Reson Imaging, Jul, 2024, Vol. 15, No. 7


           功能MRI定量评估局部进展期直肠癌新辅助

           放化疗后病理完全缓解研究进展

              1, 2
           杨澳 ，周鹏    2*

           作者单位  1. 电子科技大学医学院，成都 610051；2. 四川省肿瘤临床医学研究中心，四川省肿瘤医院•研究所，四川省癌症防治中
           心，电子科技大学附属肿瘤医院影像科，成都 610041
           * 通信作者  周鹏，E-mail: penghyzhou@126.com
           中图分类号  R445.2；R735.37  文献标识码  A  DOI  10.12015/issn.1674-8034.2024.07.035
           本文引用格式  杨澳, 周鹏 . 功能 MRI 定量评估局部进展期直肠癌新辅助放化疗后病理完全缓解研究进展[J]. 磁共振成像, 2024,
           15(7): 210-215.
           [摘要]  新辅助放化疗（neoadjuvant chemoradiotherapy, nCRT）可降低局部进展期直肠癌（locally advanced rectal cancer, LARC）
           患者的局部复发率，提高保肛率。部分患者在nCRT后可达到病理完全缓解（pathologic complete response, pCR），这类患者采取
          “等待观察”策略，可避免手术导致的相关并发症。功能磁共振成像（functional magnetic resonance imaging, fMRI）从细胞水平
           反映肿瘤微环境结构及功能的改变，较常规 MRI 可更为准确地评估 LARC 患者对 nCRT 的反应。本文围绕扩散加权成像
          （diffusion-weighted imaging, DWI）及其衍生序列和灌注成像定量评估LARC患者nCRT后pCR研究进展予以综述，比较了DWI、
           体素内不相干运动（intravoxel incoherent motion, IVIM）、拉伸指数模型（stretched exponential model, SEM）、扩散峰度成像
          （diffusion kurtosis imaging, DKI）、动态对比增强磁共振成像（dynamic contrast-enhanced MRI, DCE-MRI）和基于人工智能的预
           测模型在当前研究中的优势与不足，并为未来的研究方向提供了线索和思路，旨在为准确识别 pCR的 LARC患者提供较为可靠
           的定量指标。
           [关键词]  局部进展期直肠癌；新辅助放化疗；病理完全缓解；功能磁共振成像；磁共振成像
           Progress  of  quantitative  prediction  of  the  pathologic  complete  response  after  neoadjuvant
           chemoradiotherapy for locally advanced rectal cancer with functional MRI

                   1, 2
           YANG Ao , ZHOU Peng 2*
                                                                                           2
           1 School of Medicine University of Electronic Science and Technology of China, Chengdu 610051, China;  Department of Radiology,
           Sichuan Clinical Research Center for Cancer, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, Affiliated Cancer Hospital of
           University of Electronic Science and Technology of China, Chengdu 610041, China
           * Correspondence to  ZHOU P, E-mail: penghyzhou@126.com
           Received  1 Mar 2024, Accepted  26 Jun 2024; DOI  10.12015/issn.1674-8034.2024.07.035
           ACKNOWLEDGMENTS  Sichuan Province Science and Technology Program (No. 2022YFSY0006, 2021YFG0125).
           Cite  this  article  as   YANG A,  ZHOU  P.  Progress  of  quantitative  prediction  of  the  pathologic  complete  response  after  neoadjuvant
           chemoradiotherapy for locally advanced rectal cancer with functional MRI[J]. Chin J Magn Reson Imaging, 2024, 15(7): 210-215.
           Abstract  Neoadjuvant  chemoradiotherapy  (nCRT)  could  reduce  the  local  recurrence  rate  and  improve  the  anus-preserving  rate  in
           patients with locally advanced rectal cancer (LARC). Some patients can achieve pathologic complete response (pCR) after nCRT, who
           will  be  take  "watch  and  wait"  strategy,  and  the  patients  could  be  avoid  the  complications  caused  by  surgery.  Functional  magnetic
           resonance imaging (fMRI) can more accurately assess patients' response to nCRT than conventional MRI by reflecting changes in the
           structure  and  function  of  the  tumor  microenvironment  at  the  cellular  level.  In  this  paper,  we  review  the  research  progress  on  the
           quantitative evaluation of pCR after nCRT by diffusion-weighted imaging (DWI) and its derived sequences and perfusion imaging in
           patients with LARC, compare the advantages and disadvantages of DWI, intravoxel incoherent motion (IVIM), stretched exponential
           model  (SEM),  diffusion  kurtosis  imaging  (DKI),  dynamic  contrast-enhanced  MRI  (DCE-MRI),  and  artificial  intelligence-based
           prediction models in the current research, and provide clues and ideas for future research directions, aiming to provide relative reliable
           quantitative indicators for accurately identifying patients with LARC who achieve pCR.
           Key  words   locally  advanced  rectal  cancer;  neoadjuvant  chemoradiotherapy;  pathologic  complete  response;  functional  magnetic
           resonance imaging; magnetic resonance imaging


           0 引言                                                放化疗（neoadjuvant chemoradiotherapy, nCRT）或新辅助
                                                                   [2]
               2020 年全球癌症统计报告显示，我国结直肠癌                         化疗 ，这有利于降低局部复发率，提高根治性手术切
                                                                                                           [3]
           发病率和死亡率分别占全部恶性肿瘤的第 2 和第                             除率。在接受nCRT的患者中，大约有4.2%~21.3% 患
                                                    [1]
           5 位，且多数患者在确诊时已处于局部进展期 。中                            者可达到病理完全缓解（pathologic complete response,
                                                                                               [4-5]
           国结直肠癌诊疗规范（2023 年版）推荐术前影像学分                          pCR），根据 Dworak 肿瘤消退分级 （tumor regression
           期 T3~T4 期和（或）淋巴结转移的局部进展期直肠癌                         grade, TRG），pCR 被定义为无肿瘤细胞残留，只有纤
          （locally advanced rectal cancer, LARC）患者行新辅助         维化。有研究表明达到 pCR 的患者在接受全直肠系


           收稿日期  2024-03-01  接受日期  2024-06-26
           基金项目  四川省科技计划项目（编号：2022YFSY0006、2021YFG0125）

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