磁共振扩散加权成像对肝癌TACE术后的影像分析及指导价值  

The image analysis and guiding value of magnetic resonance diffusion-weighted imaging in the follow-up of liver cancer after transcatheter arterial chemoembolization

作　　者：陈曦[1] 李洁[1] 吴巍[1] 赵瑞坤[1] 隋长平 

机构地区：[1]吉林省肿瘤医院放射线科,长春130012

出　　处：《临床肝胆病杂志》2011年第9期976-979,共4页Journal of Clinical Hepatology

基　　金：吉林省科技发展计划（200705440）

摘　　要：目的探讨磁共振（MR I）扩散加权成像（DW I）对肝癌经导管动脉化疗栓塞术（TACE）术后疗效的影像评估及指导价值。方法搜集30例行TACE治疗的巨块型肝癌患者,于术前24～48 h、术后24～48 h、14～16 d及30～32 d（二次TACE术前）行MR I平扫、增强及DW I扫描,b值选300、600及800 s/mm2,比较不同时间段瘤区组织的平均表现扩散示数（ADC）值的变化并观察同期肿瘤MR I信号变化。结果术后各组肝癌组织的ADC值较术前明显升高（P〈0.05）,术后14～16 d病变ADC值最高,是肿瘤细胞液化、坏死高峰期。术后30～32 d ADC值下降,与二次TACE对比,肿瘤细胞都有不同程度的复发。二次TACE发现病变18处,MR I平扫及增强诊断相符率85.7%。DW I诊断相符率94.7%。不同b值图像分析,b值选600 s/mm2时,图像较清晰,病变敏感性高。结论核磁功能成像DW I对肝癌TACE术后肿瘤细胞残存、复发具有高敏感性、特异性,可有效评估肝癌TACE术后疗效,指导临床治疗方案。Objective Our aim is to evaluate the clinical value of image assessment and guidance of MR diffusion-weighted imaging（DWI） on liver transcatheter arterial infusion chemotherapy embolization（TACE）.Methods 30 cases of giant hepatic carcinoma patients were collected.The patients underwent the DWI scan 24-48 hours pre-operation and 24-48 hours,14-16 days and 30-32 days post-operation（before the second TACE）.The machine include Siemens Espree 1.5T magnetic resonance imaging machine with b values of 300,600 and 800 s/mm2.The average ADC values and the MRI signal value of tumor in different time were compared.Results All the ADC values of post-operation hepatocellular carcinoma were significantly higher than that of pre-operation（P0.05）,the ADC value arrived the peak in 14-16 days post-operation because of the liquefaction and necrosis of tumor cells.The ADC values decreased at the 30-32 days post-operation.Compared with the second TACE,the tumor recurred at different degrees.18 lesions were found in the second TACE,the diagnosis consistent rate of MRI with enhance scan was 85.7%,that of DWI was 94.7%.By analyzing the images of different b,there was the clearest images and highest sensitivity when b was 600 s/mm2.Conclusion DWI is with high sensitivity and specificity for residue or recurrence lesions of liver cancer patients after TACE,and it is an effective method.

关 键 词：磁共振成像 肝肿瘤 化学栓塞 治疗性 

分 类 号：R816.5[医药卫生—放射医学]