弥散成像在肝细胞肝癌及TACE治疗后的应用  

Diffusion Weighted Imaging in Hepatocellular Carcinoma and TACE Monitoring

作　　者：吴斌[1] 彭卫军[1] 陈灏[2] 刘鲁明[2] 唐峰[1] 李建奇[3] 顾雅佳[1] 杨天锡[1] 

机构地区：[1]复旦大学附属肿瘤医院放射诊断科 [2]复旦大学附属肿瘤医院中西医结合科 [3]华东师范大学物理系

出　　处：《中国医学计算机成像杂志》2007年第3期178-183,共6页Chinese Computed Medical Imaging

基　　金：国家自然科学基金(30470503);上海市科委重点项目(04JC14074);上海市教委基金(03J405037)~~

摘　　要：目的:探讨磁共振弥散加权成像(DWI)在肝细胞肝癌(HCC)的应用及介入治疗前后监测肿瘤变化的价值。材料和方法:11例确诊HCC进行屏气状态下多个弥散梯度因子(b值=200s/mm^2、400s/mm^2、600s/mm^2、1000s/mm^2、2000s/mm^2)的弥散加权成像,选用自旋平面回波(SE-EPI)序列(TR/TE=2000/46.7-78.1ms,层厚:8mm,层距:2mm),对肿瘤层面的瘤灶、邻近未累及肝实质区与背景噪声的信号强度(SI)进行测量,并观察经皮插管肝动脉化疗栓塞(TACE)术治疗前后肿瘤表观弥散系数(ADC)值的变化趋势。结果:随着b值的增加,肝脏DWI图像质量呈下降趋势。低b值DWI图像清晰但存在较明显的T_2透过效应;高b值时则图像模糊信号接近于背景噪声,当b值取600s/mm^2时,肝癌肿瘤与肝实质之间存在着最佳对比度。介入治疗后肿瘤的ADC值普遍有所增大,其中高b值时两者之间存在统计学差异。结论:屏气状态下DWI在肝脏肿瘤的应用完全可行,ADC值在介入治疗前后的变化趋势可能具有监测肿瘤内部坏死情况的价值。Purpose： To investigate the magnetic resonance diffusion weighted imaging of hepatocellular carcinoma and to monitor the early response of the tumor after TACE. Materials and Methods： Multi - b value DWI was performed in 11 confirmed HCC with spin - echo sequence under breath - hold status. The average signal intensity of tumor was measured as well as uninvolved liver parenchyma, background noise. The signal intensity and ADC value changes of iodized- oil retention and non - retention region after TACE were also recorded with plain CT. Results： Quality of picture was degrade with the increase of b value. The image of DWI with low b value had obvious T2 shine effect however those with high b value had poor contrast against background. It had the best contrast between tumor and liver parenchyma when b value was 600. The signal intensity of tumor diminished while the ADC value increased after TACE. There were discrepancy between signal intensity and ADC value changes in iodized - oil retention and non - retention region of tumor.Conclusion： Breath - hold MR DWI is feasible in HCC and has the potential in detecting the tumor necrosis after TACE in early stage

关 键 词：肝细胞肝癌 磁共振成像 弥散加权成像 经皮插管肝动脉化疗栓塞 

分 类 号：R735.7[医药卫生—肿瘤]