3.0 T磁共振弥散加权成像评价肝细胞癌TACE联合射频消融治疗的临床疗效  

Clinical study of transcatheter arterial chemoembolization plus radiofrequency ablation in hepatocellular carcinoma by magnetic resonance imaging and functional diffusion-weighted imaging

作　　者：刘于宝[1] 梁长虹[1] 王秋实[1] 谢淑飞[1] 余元新[1] 张忠林[1] 刘再毅[1] 

机构地区：[1]广东省人民医院广东省医学科学院放射科,广州510080

出　　处：《中华医学杂志》2010年第41期2922-2926,共5页National Medical Journal of China

基　　金：广东省医学科学技术研究基金（A2009018）

摘　　要：目的 探讨肝细胞癌（HCC）经导管动脉内化疗栓塞（TACE）联合射频消融治疗后3.0T MR弥散加权成像表观弥散系数（ADC）值特征,评价3.0T MRI及ADC值在肝细胞癌TACE联合射频消融治疗后监测肿瘤变化的价值.方法 收集2008年1月至2009年10月广东省人民医院28例肝细胞癌患者.所有患者均为先行TACE治疗,TACE治疗后对局部肿瘤复发或残留者行射频消融治疗,射频消融后1～4个月行MRI常规及弥散加权成像（DWI）检查.b值选择600 s/mm2.分析TACE联合射频消融治疗后病灶不同区域ADC值特征.评价增强扫描序列、DWI评价TACE联合射频消融治疗后病灶的差别.结果 28例肝细胞癌经TACE联合射频消融治疗后病灶中,局部肿瘤残留或复发14例.b值为600 s/mm2时含碘油坏死组织、不含碘油坏死组织、活性肿瘤组织、正常肝组织ADC值分别为（1.905±0.487）、（0.726±0.116）、（1.449±0.054）、（1. 777±0.094）×10-mm2/s.含碘油坏死组织与正常组织间ADC值差异有统计学意义（P=0.115）,含碘油坏死组织、不含碘油坏死组织、活性肿瘤组织间ADC值两比较差异有统计学意义（P＜0.05）.TACE联合射频消融治疗后活性肿瘤组织病灶位于TACE、消融灶周边,呈结节状突向TACE、消融灶内.不含碘油坏死组织位于含碘油坏死组织周围,增强扫描各期均无强化.增强扫描序列、DWI判断TACE联合射频消融治疗 后活性残留或复发肿瘤敏感性、特异性差异无统计学意义（P＞0.05）.结论 3.0T MR弥散加权成像ADC值可用于鉴别肝细胞癌TACE联合射频消融治疗后坏死组织与复发或残留肿瘤组织.Objective To evaluate the apparent diffusion coefficient（ADC）value features of the lesions after transcatheter arterial chemoembolization（TACE）plus radiofrequency ablation in hepatocellular carcinoma（HCC）with 3.0T magnetic resonance imaging（MRI）and diffusion-weight imaging（DWI）and analyze the value of 3.0T DWI in detecting the pathological lesion features of post-TACE plus radiofrequency ablation in HCC. Methods Twenty-eight HCC patients were enrolled to receive TACE firstly. Then all viable rumors around the lesions underwent radiofrequency ablation. At 1-4 months after radiofrequency ablation, 3.0T MRI and DWI（b = 600 sec/mm2）were performed to measure the ADC values of different lesions of post-TACE plus radiofrequency ablation. The features of MRI and ADC values of different lesions,the difference of contrast enhancement sequence and DWI in evaluating the lesions of post-TACE plus radiofrequency ablation were analyzed. Results Viable tumors occurred in 14 of 28 HCC patients after TACE plus radiofrequency ablation. The ADC values of necrotic tissues with lipiodol, necrotic tissues without lipiodol, viable tumors and normal liver tissues were 1.905±0.487, 0.726±0.116, 1.449±0.054and 1.777±0.094（10-3 mm2/sec）respectively. There was no significant difference of ADC values between necrotic tissues with lipiodol and normal tissues（P =0. 115）. But there were significant differences of ADC values among necrotic tissues with lipiodol, necrotic tissues without lipiodol and viable tumors（P 〈0. 05）. The viable tumor tissues after TACE plus radiofrequency ablation appeared as nodular lesions with slightly heightened signal intensities around the necrotic tissues, the lesions with heterogeneous enhancement during arterial phase, portal vein phase and parenchymal phase. Necrotic tissues without lipiodol occurred outside necrotic tissues without lipiodol, around normal liver tissues, with low signal intensities on T2WI,without enhancement during arterial phase, portal vein phase and p

关 键 词：癌 肝细胞 药物疗法 联合 导管消融术 磁共振成像 

分 类 号：R686[医药卫生—骨科学]