磁共振动态增强扫描及弥散加权成像对肝癌肝动脉化学栓塞治疗的疗效判断  

Evaluation of Dynamic Contrast-Enhanced MRI and Diffusion Weighted Imaging in Judging the Therapeutic Effect on Hepatocellular Carcinoma after Transcatheter Arterial Chemoembolization

作　　者：邱丽华[1] 曹跃勇[1] 朱建军[2] 袁志平[3] 朱军[1] 敖永胜[1] 刁显明 

机构地区：[1]宜宾市第二人民医院放射科,四川宜宾644000 [2]宜宾市第二人民医院预防保健科,四川宜宾644000 [3]宜宾市第二人民医院肿瘤科,四川宜宾644000

出　　处：《华西医学》2011年第9期1351-1355,共5页West China Medical Journal

基　　金：四川省卫生厅科学研究资助项目(090561)~~

摘　　要：目的探讨磁共振动态增强扫描及磁共振弥散加权成像（diffusionweightedimaging，DWI）对肝癌经导管动脉内化学栓塞（transcatheterarterialchemoembolization，TACE）治疗后的肿瘤残余及复发的判断价值。方法2009年1月-2010年10月，对28例经证实的肝癌患者在TACE治疗前、治疗后3～7d及治疗后1～2个月、3～6个月行磁共振动态增强及DWI扫描，动态测量表观弥散系数（apparentdiffusioncoefficient，ADc）值，与数字减影血管造影（digitalsubstractionangiography，DSA）检查对照，评价动态增强扫描及DWI对肿瘤残留或复发的检出能力。结果对肿瘤残余及复发的显示，动态增强扫描灵敏度为90．O％，特异度为96．9％；DWI灵敏度为96．7％，特异度为93．8％；动态增强扫描与DWI相结合的灵感度为100．0%，特异度为99．5％；DSA灵敏度和特异度分别为96．7％、100．0％。TACE治疗前所有肿瘤实质的ADC值为（1．134±0．014）×10^-3～mm^2／s；TACE治疗后3～7dAYX3值为（1．162±0．016）×10^-3～mm^2／s；TACE治疗后1～2个月碘油沉积较好，无明显残余或复发病灶的ADC值为（1.175±0．015）×10^-3mm^2／s，3～6个月后随访病灶ADC值为（1．179土0．017）×10。mm2／s；TACE治疗后1～2个月碘油沉积不完全或无明显沉积病灶ADC值为（1．147±0．016）×10^-3～mm^2／s，3～6个月后随访病灶实质平均ADC值（1．142±0．012）×10^-3～mm^2／s。结论将动脉增强扫描与DWI相结合可提高对TACE治疗后肝癌残余及复发判断的灵敏度及特异度；对肿瘤组织平均ADC值的动态测量、观察可及早判断肿瘤复发的可能性。Objective To evaluate the dynamic contrast-enhanced MRI and diffusion weighted imaging （DWI） in judging the remnant and recurrence on hepatocellular carcinoma （HCC） after transcatheter arterial chemoembolization （TACE）. Methods Between January 2009 and October 2010, 28 patients with HCC underwent dynamic contrastenhanced MRI and DWI before and after TACE 3-7 days, 1-2 months and 3-6 months, respectively, and the apparent diffusion coefficient （ADC） value of the tumor were also measured at above mentioned time points. The sensitivity and specificity of dynamic contrast-enhanced MRI and DWI in diagnosis of residual tumor and recurrent cancer was qualitatively evaluated by comparing with the DSA results. Results Compared with DSA, the sensitivity and specificity of dynamic contrast-enhanced MRI were 90. 0% and 96. 9% by revealing the remnant and recurrence of HCC, while the sensitivity and specificity of DWI were 96. 7% and 93.8% respectively. Combining dynamic contrastenhanced MRI and DWI the sensitivity and specificity were improved to 100. 0% and 99. 5%, respectively. The mean ADC value of tumor before and after 3-7 days of TACE were （1. 134±0. 014） × 10^-3 and （1. 162±0. 016） ×10^-3 mm^2/s, respectively. The mean ADC value of tumor without and with remnant and recurrence after 1-2 months and3-6 months follow up were （1. 17510^-30. 015） × 10^-3, and （1. 179±0. 017） 10^-3 mm^2/s; （1. 147±0. 016） 10^-3 and （1. 142 ± 0. 012） 10^-3 a mm^2 /s, respectively. Conclusions Combining dynamic contrast-enhanced MRI and DWI could improve the sensitivity and specificity to detect the remnant and recurrence of HCC after TACE. Measuring the ADC value during follow up of HCC patients after TACE could predict the probability of tumor recurrence.

关 键 词：肝肿瘤 化学栓塞 治疗 磁共振成像 扩散加权成像 动态增强扫描 

分 类 号：R445.2[医药卫生—影像医学与核医学] R735.7[医药卫生—诊断学]