肝细胞癌射频消融术后短期侵袭性复发与功能MRI的相关性研究  

Correlation analysis between short-term invasive recurrence and functional MRI after radiofrequency ablation of hepatocellular carcinoma

作　　者：叶卫川 陈春妙 吴徐璐 张登科[1] 刘旦[1] 李洁[1] 赵中伟[1] 胡祥华 纪建松[1] Ye Weichuan;Chen Chunmiao;Wu Xulu;Zhang Dengke;Liu Dan;Li Jie;Zhao Zhongwei;Hu Xianghua;Ji Jiansong(Department of Radiology,Lishui Hospital of Zhejiang University,Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research,Lishui 323000,China)

机构地区：[1]浙江大学丽水医院放射科浙江省影像诊断与介入微创研究重点实验室,323000

出　　处：《中华放射学杂志》2020年第1期28-32,共5页Chinese Journal of Radiology

基　　金：浙江省公益技术研究计划(LGF19H180009,LGF19H180010);丽水市高层次人才项目(2016RC29);浙江省医药卫生项目(2017KY728)。

摘　　要：目的探讨动态对比增强MRI扩散加权成像(DWI)评估肝细胞癌(HCC)射频消融术(RFA)后短期内侵袭性分段复发(AIR)的价值。方法回顾性分析2012年1月至2018年6月浙江大学丽水医院HCC行RFA治疗后3个月内影像学随访出现AIR的患者作为AIR组,1262例经RFA治疗的HCC患者中纳入30例AIR患者。任意选取35例同期经RFA治疗未发生AIR的HCC患者作为对照组。患者均在术前行动态增强MRI(DCE-MRI)及DWI扫描。观察病灶形态、病灶动脉早期强化方式、早期强化率,并测定表观扩散系数(ADC)值。采用χ2检验、独立样本t检验比较AIR组和对照组间计量资料和计数资料的差异,采用Pearson法评价AIR与功能MRI参数的相关性。结果AIR组肿瘤在Ⅰ段和Ⅳ段多于对照组,差异有统计学意义(P<0.05),在其他肝段的病灶数量差异无统计学意义(P>0.05)。AIR组和对照组患者的病灶形态差异无统计学意义(P>0.05);2组患者的病灶动脉早期强化方式、动脉早期强化率和ADC值差异均有统计学意义(P<0.05),其中AIR组患者多为不均匀强化,动脉早期强化率和ADC值均低于对照组。AIR与病灶动脉早期强化方式、动脉早期强化率、ADC值、病灶位于肝段Ⅰ、病灶位于肝段Ⅳ均呈正相关,r值分别为0.455、0.633、0.518、0.375和0.287,P均<0.05。结论HCC患者行RFA后短期内的AIR与病灶功能成像参数(动脉早期强化方式、动脉早期强化率、ADC值)及其所在肝段(Ⅰ、Ⅳ段)具有相关性。Objective To explore and clarify the correlation between short-term aggressive intrasegmental recurrence(AIR)and functional magnetic resonance imaging after radiofrequency ablation of hepatocellular carcinoma(HCC).Methods A retrospective analysis of 1262 patients with HCC who underwent radiofrequency ablation(RFA)in our hospital from January 2012 to June 2018,all patients were confirmed by pathology as HCC,of which 30 patients were found to have AIR during radiographic follow-up within 3 months after surgery,another 35 patients with disease progression who were controlled in a short period of time were randomly selected as the control group.All the enrolled patients underwent dynamic enhanced magnetic resonance imaging(DCE-MRI)and diffusion weighted imaging(DWI)scanning before surgery,and the differences in clinical data,lesion location,and functional magnetic resonance parameters between the two groups were compared,and their correlation with AIR after RFA was analyzed.Chi-square test,t test and Pearson test were used.Results The lesions in the AIR group were significantly more in theⅠandⅣsegments than that in the control group(P<0.05),and there was no significant difference in other liver segments(P>0.05).There was no significant difference in the lesion morphology between the two groups(P>0.05),and there was a significant difference in the early enhancement pattern of the lesions(P<0.05),and the early arterial enhancement rate and apparent diffusion coefficient(ADC)value of the AIR group were significantly lower than the control group(P<0.05).Further correlation analysis found that early enhancement of the arterial artery,early arterial enhancement rate,ADC value and lesion location were associated with AIR and were positively correlated,r values were 0.455,0.633,0.518,0.375 and 0.287(P<0.05).Conclusion The short-term AIR and functional imaging parameters(arterial early enhancement,early arterial enhancement rate,ADC value)and the liver segment(ⅠandⅣ)were highly correlated with radiofrequency ablation.

关 键 词：肝肿瘤 射频消融 侵袭性分段复发 磁共振成像 

分 类 号：R735[医药卫生—肿瘤] R44[医药卫生—临床医学]