TACE联合重组人血管内皮抑制素治疗原发性肝癌后的DWI评估价值  

Clinical Application of DWI in Evaluating TACE Combine with Endostar for the Treatment of Primary Hepatic Carcinoma

作　　者：陈国硕 汤日杰[1] 候毅斌 李建生[1] 张海南[1] 王峻[1] 段光峰[1] 卢斌贵[1] 

机构地区：[1]广州医科大学附属肿瘤医院放射科,广州510095

出　　处：《临床放射学杂志》2015年第1期115-119,共5页Journal of Clinical Radiology

摘　　要：目的探讨经导管肝动脉化疗栓塞术(TACE)联合重组人血管内皮抑制素(恩度)治疗原发性肝癌后扩散加权成像(DWI)检测的准确性。方法搜集2012年5月至2013年2月本科收治的15例原发性肝癌患者的临床及影像学资料。15例均在首次行TACE联合恩度治疗后35天左右第二次介入术前使用常规MRI(A组)、DWI(B组)及两者结合(C组)三种方法检测TACE联合恩度的疗效,并以第二次术中肝动脉造影所见肝内<2 cm病灶为参照标准,评价三种检测方法对TACE联合恩度治疗后肝内<2 cm病灶诊断准确性的差异。结果第二次介入术中DSA肝动脉造影明确<2 cm病灶63个,其中肿瘤染色病灶42个,碘油沉积完整、未见肿瘤染色病灶21个。A组检出的病灶和碘油沉积灶分别为35和28个,B组分别为36和27个,C组分别为41和22个。A组诊断敏感度69%、特异度为71.4%,阳性预测值82.5%,阴性预测值53.5%;B组为80.9%、90.4%、94%、70.3%,C组为95.2%、95.2%、97.5%、90.9%;AC、BC两组对TACE联合恩度治疗后病灶的检出差异有统计学意义(分别为χ2=9.820,P=0.02和χ2=4.086,P=0.043);AB组间病灶检出无统计学差异(χ2=1.587,P=0.208)。C组术后肝癌病灶最佳诊断阈值ADC值为1.356×10-3mm2/s,敏感度为95.2%,特异度为82.9%。结论 DWI单项检测对TACE联合恩度治疗术后评价没有优势,但结合常规MRI扫描可提高对病灶检出的准确度和敏感度,对手术前诊断和术后疗效评估具有一定价值。Objective To discuss the clinical value of MR diffusion weighted imaging （DWI） in evaluating transcathe- ter arterial chemoembolization （TACE） combined with recombinant human endostatin （Endostar） for the treatment of pri- mary hepatocellular carcinoma （HCC）. Methods The clinical data and imaging material of 15 patients with HCC, who were admitted to authors＇ hospital daring the period from May 2012 to Feb. 2013, were retrospectively analyzed. Conven- tional MRI （group A） , DWI （group B） and both MRI and DWI （group C ） were performed in the patients at about 35 days after the initial TACE combined with Endostar treatment and before the performance of second interventional therapy to check the therapeutic effect. Taking intrahepatic 〈 2cm lesions, which were demonstrated on hepatic artery angiography performed during the second TASCE, as the reference standard, the diagnostic accuracies of three groups for less than 2 cm lesions were compared. Results DSA performed during the second TACE detected 63 lesions of less than 2 cm in the liv- er. Tumor stain was seen in 42 lesions; and in other 21 lesions complete Lipiodol deposit was observed with no tumor stain. The numbers of the detected lesion and Lipiodol- deposited lesion in group A, B and C were 35 and 28, 36 and 27, 41 and 22 respectively. The diagnostic sensitivity, specificity, positive predictive value and negative predictive value were 69%, 71.4%, 82.5% and 53.5% respectively in group A, were 80.9%, 90.4%, 94% and 70.3% respectively in group B, and were 95.2%, 95.2% , 97.5% and 90.9% respectively in group C. Statistically significant difference in the detection rate of hepatic lesions after TACE combined with Endostar treatment existed between group A and group B （ X2 =9. 820, P = 0.02） as well as between group B and group C （ X2 = 4. 086, P = 0. 043 ）. The difference in the detection rate of hepatic lesions between group A and group B was not significant （ X2 = 1. 587, P = 0. 208 ）. The optimal diagnostic thresho

关 键 词：肝动脉化疗栓塞 表观扩散系数 抗血管生成 扩散加权成像 

分 类 号：R735.7[医药卫生—肿瘤]