肝癌经导管动脉灌注化疗栓塞术疗效的MR扩散加权成像动态研究  

Dynamic study of efficacy of transcatheter arterial chemoembolization(TACE) of primary liver carcinoma with the MR diffusion-weighted imaging(DWI)

作　　者：尚全良[1] 肖恩华[1] 贺忠[1] 谭利华[1] 司徒卫军[1] 白末了[1] 袁术文[1] 杜万平[1] 

机构地区：[1]中南大学湘雅第二医院放射科,长沙410011

出　　处：《中华放射学杂志》2006年第3期235-240,共6页Chinese Journal of Radiology

基　　金：国家自然科学基金(30070235;30470508);湖南省科技厅基金项目(04-SK-306-2);湖南省中医药管理局基金(202064;204057)

摘　　要：目的 探讨MR扩散加权成像（DWI）在原发性肝癌经导管动脉化疗栓塞术（TACE）疗效动态评价中的作用。方法 在15 T GE Signa Twin speed MR机上，取扩散敏感梯度因子（b值）为0及800s／mm^2，利用固定参数组合的自旋回波-平面回波（SE—EPI）序列对首次行TACE治疗的25例肝癌肿块分别于术前24～48h、术后36～48h、术后7～10d、术后30～38d内各进行1次DWI，对每次的图像进行后处理，计算出每例肝癌每个时点的表观扩散系数（ADC值），对各个时点的ADC值进行对比研究，并结合第1次TACE术后与第2次TACE术前肿瘤的血管造影染色及碘油沉积的改变判断肿瘤的复发情况。结果 术前24～48h、术后36～48h、术后7～10d、术后30～38d组的ADC值分别为（1376±0012）×10^-3mm^2／s、（1598±0012）×10^-3mm^2／s、（1723±0012）×10mm^-3／s、（1684±0012）×10^-3mm^2／s。术后各组肝癌组织的ADC值较术前明显升高（P〈005）；术后7～10d、术后30～38d组的ADC值较术后36～48h组明显升高（P〈005）；术后30～38d的ADC值较术后7～10d组明显降低（P〈005）。将第1次TACE术后与第2次TACE术前的造影片及碘油沉积片对比见术后30～38dADC值下降的肝癌病例都有不同程度的复发，ADC值下降明显的复发也最为明显。结论 利用MRDWI技术对肝癌组织的ADC值进行动态观察，可以评价肝癌TACE术后癌组织的坏死、复发情况。Objective To dynamically evaluate the efficacy of treatment of primary liver carcinolna （ PLC ） by transcatheter arterial chelnoelnbolization（ TACE ） with the MR diffusion-weiglrted ilnaging（ DWI ）. Methods DWI and the lneasurelnent of lnean apparent diffusion coeffecient（ADC） value were performed in 25 lnasses of PLC with the same SE-EPI sequence （ b = 800 s/mm^2 and 0） at 1.5 T MRI within the 24 48 hours before TACE （group A） and 3648 hours, 7 10 days,30-8 days after TACE （group B, group C, group D）. The differences of the lnean ADC values of PLC between groups were analyzed. Results The lnean ADC values of the three groups after TACE the mean ADC value of group B： （ 1. 598 ± 0. 012） × 10 ^-3mm^2/s, the lnean ADC value of group C： （ 1. 723±0. 012） × 10^-3mm^2/s, the mean ADC value of group D： （1. 684 ± 0. 012） × 10 ^-3mm^2/s were significantly greater than that of the group before TACE the lnean ADC value of group A： （ 1. 376 ± 0. 012） × 10-3mm^2/s（ P 〈 0. 05 ）. The lnean ADC values of the group C and the group D were significandy greater than that of the group B （P 〈 0. 05）. The lnean ADC values of the group D was lower than that of the group C （P 〈 0. 05）. Through contrasting the digital subtraction angiography （DSA） ilnaging of the second TACE with thot of the first TACE, we found that every PLC whose mean ADC value after 3048 days of the TACE was lower than that after 7- 10 days of the TACE could be found the recurrence, especially in those PLC whose lnean ADC values were decreased greatly. Conclusion With the lneasurelnent of ADC value of the different tilne of the PLC we could excellently evaluate the necrosis and the recurrence of the PLC after the operation of the TACE.

关 键 词：癌 肝细胞 磁共振成像 扩散 化疗栓塞 治疗性 

分 类 号：R735.7[医药卫生—肿瘤]