MR全身扩散加权成像技术在肿瘤病变中的应用价值  

The application value of whole body diffusion-weighted imaging in tumor lesions

作　　者：龚佳英 周智洋[1] 邓艳红[2] 康亮[3] 曹务腾[1] 练延帮[1] 邱建平[1] 熊斐[1] 李文儒[1] 李雯莉[1] 

机构地区：[1]中山大学附属第六医院放射科,广州5106552 [2]中山大学附属第六医院肿瘤内科,广州5106303 [3]中山大学附属第六医院结直肠外科,广州510630

出　　处：《磁共振成像》2013年第6期420-425,共6页Chinese Journal of Magnetic Resonance Imaging

基　　金：广东省科技厅社会发展与基础研究项目(编号:2011A030400003);广东省产学研合作科技创新平台项目(编号:2012B090600044)

摘　　要：目的探讨MR背景抑制全身扩散加权成像(WB-DWI)在全身肿瘤原发灶及远处转移灶显示、疗效评估以及术后随访中的应用价值。材料与方法使用美国GE Optimal 360型1.5 T光纤MR扫描仪,信号采集使用磁体内置BODY线圈,采用反转恢复回波平面扩散序列(STIR-DWI-EPI),对7名健康志愿者及70例临床确诊为恶性肿瘤或临床疑似肿瘤患者行WB-DWI检查,同时采集全身轴面DWI和与其同层对应的ADC图,应用AW 4.5 Functool DWI后处理软件,经三维最大密度投影重建及黑白反转后形成全身"类-PET-MRI"图像。对所有WB-DWI影像与常规MRI影像表现比较分析。结果 7名健康志愿者及70例患者均获得高质量的WB-DWI图像,原发灶及转移灶在DWI图像上均呈高信号,ADC图为低信号,健康志愿者均未发现恶性病变。70例患者中,30例为新辅助治疗前或术前行WB-DWI检查明确原发灶或评价远处转移情况,其中12例检出转移灶;11例为评价新辅助治疗后局部病灶及远处转移灶疗效情况,病灶或转移灶较前缩小、增大、无明显变化例数分别为6例、3例、2例,1例甚至达到临床缓解,即在常规MRI检查及WB-DWI影像上未见异常强化灶及异常高信号影;28例为手术综合治疗后随访,其中16例未见局部复发及其他脏器转移,5例肿瘤局部复发,7例检出远处其他脏器转移;1例大量腹水查因患者经检查后发现右侧大腿肌群间异常高信号,病理证实为血管瘤。结论类-PET-MRI技术对发现全身恶性肿瘤患者的原发灶及远处转移灶非常敏感,能更早、更准确地对肿瘤的诊断、分期、预后和综合疗效评估提供指导意义。与PET-CT相比,类-PET-MRI技术无辐射、无需注射对比剂、检查方便快捷、经济,更适合于肿瘤患者治疗前后的疗效评估和随访,同时也适合健康人群肿瘤筛查。Objective： To investigate the clinical value of whole body diffusion- weighted imaging （WB-DWI） in discovery of malignant primary tumor and metastasis, assessment of tumor response to neoadjuvant therapy and postoperative follow- up. Materials and Methods： Fiber magnetic resonance scanner（GE Optimal 360 1.5 T, US） and short T1 inversion recovery echo-planar imaging diffusion weighted sequence （STIR-EPI-DWI） and body coil were used to obtain the WB-DWI for 7 volunteers and 70 diagnosed or suspected cancer patients. Meanwhile, all axial DWI and corresponding ADC figure with the same layer were collected. Then, the WB-DWI images were reconstructed using the three-dimensional maximum intensity projection（MIP） and inverted-gray-scale with AW 4.5 Functool DWI post processing software and images similar to PET images can be achieved. All WB-DWI images were compared with conventional MRI scanning. Results： High quality WB-DWIimages were obtained for 7 volunteers and 70 patients. The primary tumor and metastatic lesions showed high signal on DWI images and low signal on ADC figures, and malignant lesions were not found in volunteers. Twelve cases in 30 patients who intended to assess distant metastases before therapy were detected metastases. Eleven cases in 70 patients who planned to evaluate tumor and metastases response to neoadjuvant therapy, within which 6 cases reduced in size, 1 case even achieved clinical remission, while 3 cases increased and 2 cases had no change. Twenty-eight cases conducted follow-up after comprehensive treatment, 16 cases without local recurrence and metastases, 5 with local recurrence, and 7 were found metastases. One patient with massive ascites took an examination and found abnormal high signal between right thigh muscle groups, confirmed by pathology hemangioma. Conclusions： WB-DWI can provide acceptable earlier and comparable efficacy guiding significance for tumor diagnosing, staging, and prognosing, therapeutic evaluation, which is more sensitive in detecting pr

关 键 词：磁共振成像 弥散 肿瘤 肿瘤转移 

分 类 号：R445.2[医药卫生—影像医学与核医学] R73[医药卫生—诊断学]