动态对比增强MRI对结肠癌肝转移瘤TACE治疗前后微循环灌注改变及近期疗效评价  

Application of DEC-MRI in evaluating the changes of microcirculation perfusion of liver metastasis from colon cancer after TACE treatment and the short-term effect

作　　者：刘丽[1] 卲天朋 曹建民[1] 卢光明[1] 许健[1] 

机构地区：[1]南京军区南京总医院医学影像科,210002

出　　处：《介入放射学杂志》2016年第6期501-505,共5页Journal of Interventional Radiology

基　　金：国家自然科学基金(81471632)

摘　　要：目的探讨结肠癌肝转移瘤经导管动脉化疗栓塞(TACE)治疗前后动态对比增强磁共振成像(DCE-MRI)各定量参数的变化及其对预后评估的价值。方法对21例经病理证实为低分化腺癌的结肠癌肝转移患者分别于TACE术前及术后进行常规MRI和DCE-MRI扫描。以两腔室模型为基础,计算出定量血流动力学参数(K^(trans)、K_(ep)、V_e)。比较TACE术前、术后各参数的变化;分别探讨患者近期疗效与TACE术后DCE-MRI各项参数的相关性;并比较不同预后患者TACE术后各参数的差别。结果 TACE术后肿瘤组织的K^(trans)、K_(ep)及V_e值呈下降趋势,且术前术后差别有统计学意义。DCE-MRI各项参数与CEA、CA125、CA199和CA242值无明显相关性。术后近期疗效评估示完全缓解3例(14.3%),部分缓解11例(52.4%),总有效率(RR)66.7%,疾病控制率(DCR)90.5%。其中RR、PCR均与术后K^(trans)值呈正相关(r=0.526,P=0.005;r=0.557,P=0.006),但与K_(ep)、V_e值无明显相关性。结论结肠癌肝转移瘤TACE治疗前后DCE-MRI各定量血流动力学参数变化显著,术后肿瘤组织中的K^(trans)值可作为结肠癌肝转移TACE治疗早期疗效评估指标,为结肠癌肝转移瘤个体化治疗和治疗方案的修正提供依据,其远期疗效与DCE-MRI定量参数的相关性需进一步深入研究。Objective To investigate the variations of each quantitative parameter of dynamic contrast- enhanced magnetic resonance imaging （DCE-MRI） of hepatic metastasis from colon carcinoma after transcatheter arterial chemoembolization （TACE） therapy and to discuss their values in evaluation of prognosis. Methods Both conventional MRI and DCE-MRI were performed in 21 patients with pathologically proved poorly differentiated adenocarcinoma of colon before and after TACE. Based on the two-compartment model and by using the arterial input function deconvolution technique, the quantitative kinetic parameters of DCE-MRI, including K^trans, kep and Vo of the tumor tissues, were calculated. The postoperative variations of each parameter were compared with the preoperative data. The correlation between each post-TACE DCE-MRI parameter and short-term effect was separately analyzed. The differences in each parameter after TACE were compared among the patients with different prognosis. Results After TACE the K^trnas, Kep and Ve values of the tumor tissues showed a downward trend, and the changes were statistically significant when compared with the pre-TACE values. No significant correlation existed between each MRI parameter value and the levels of CEA, CA125, CA199 and CA242. The evaluation of short-term effect showed that complete remission （CR） was obtained in 3 patients （14.3%） and partial response （PR） in 11 patients （52.4%） , with the total effective rate （PR＋CR） being 66.7% and the disease control rate （DCR） 90.5%. Both （PR＋CR） and DCR had a parallel relationship with post-TACE K＇=n＊values （r=0.526, P=0.005; r=0.557, P=0.006 respectively）, although （PR＋CR） and DCR were not closely correlated with kcp and Vo values. Conclusion After TACE the DCE-MRI quantitative hemodynamic parameter values of hepatic metastasis from colon carcinoma show obvious changes. The post-TACE K^trans values of hepatic metastasis from colon carcinoma can be used as an index for the evaluation of s

关 键 词：结肠癌肝转移瘤 经导管动脉化疗栓塞术 磁共振动态增强扫描 肿瘤血管生成 微 循环灌注 

分 类 号：R735.35[医药卫生—肿瘤] R445.2[医药卫生—临床医学]