磁共振扩散加权成像在肝癌TACE术后疗效监测中的价值  

The value of apparent diffusion coefficient in monitoring tumor response to TACE of hepatic carcinoma

作　　者：潘奇[1,2] 侯炜寰[1] 李娜[1] 吕秀花[1] 汪田田[1] 刘会佳[1] 任芳[1] 黄旭方[1] 任静[1] 宦怡[1] 

机构地区：[1]第四军医大学西京医院放射科,陕西西安710032 [2]西安医学院第二附属医院影像科

出　　处：《实用放射学杂志》2014年第3期450-454,共5页Journal of Practical Radiology

摘　　要：目的 探讨磁共振（MR）扩散加权成像（DWI）在肝细胞癌（HCC）肝动脉化疗栓塞（TACE） 术后疗效监测中的价值。方法 32例经病理证实的中晚期肝癌患者于TACE术前、术后1个月行DWI及动态增强扫描检查，评价 TACE术后1月的动态增强扫描动脉早期病灶液化坏死范围，并以肿瘤坏死≥50%为标准将病灶分为有效组及无效组；通过测量TACE前后肿瘤的大小、正常肝脏组织和肿瘤的ADC值及两者差值，观察TACE术后肝癌坏死情况及肿瘤表观弥散系数（ADC）值的变化趋势，判断治疗后肿瘤残存和复发，并预测患者远期生存情况。结果 对比肝癌 TACE术前后肿瘤的ADC值变化，术后1个月ADC值普遍升高，无效组术前ADC值低于有效组，有效组术后ADC值高于无效组，无效组术前、后ADC值变化不大，有效组治疗前、后ADC值变化显著。术前、后ΔADC（%）值越大，治疗效果越好，两者之间存在统计学差异；TACE术前、后肿瘤大小及其周围正常肝脏组织ADC值变化均无统计学差异。结论 DWI作为无创性检查方法，可以早期更好地用于预测评价肝癌化疗栓塞疗效。Objective To investigate the magnetic resonance diffusion weighted imaging of hepatocellular carcinoma and to monitor the early response of the tumor after TACE. Methods A retrospective analysis of 32 cases confirmed by pathology in patients with advanced HCC in TACE before surgery a month underwent diffusion-weighted imaging and dynamic enhanced MRI examina- tion, evaluation after TACE a month of early arterial lesions in dynamic contrast enhanced scan liquefaction necrosis scope to tumor necrosis ~ 50~ for the standard will be effective group and ineffective lesions into groups by measuring the size of the tumor before and after TACE, normal liver tissue, tumor ADC value and the difference between the observed after TACE liver necrosis and tumor apparent diffusion coefficient {ADC） value trends, determined residual tumor after treatment, recurrence and predict long term sur- vival. Results TACE liver tumors before and after surgery compared ADC values change, a month after ADC values generally in- creased, invalid preoperative ADC values below the effective group, effective postoperative ADC values higher than ineffective group, ineffective group of patients before and after ADC values changed little, effective group before and after treatment ADC value changes significantly, before and after surgery AADC { % ） the larger the value, the better treatment, there was significant difference between any two; liver tumor size before and after TACE surgery ADC values of normal tissues and liver changes were not statisti- cally different. Conclusion DWI as a noninvasive method that can be used to predict a better evaluation of early liver cancer chemotherapy embolism.

关 键 词：肝细胞癌 动态增强磁共振成像 扩散加权成像 肝动脉化疗栓塞 

分 类 号：R735.7[医药卫生—肿瘤] R445.2[医药卫生—临床医学]