中晚期肝细胞癌的DCE-MRI及DWI表现与免疫治疗预后的相关性分析  

DCE-MRI and DWI findings of advanced hepatocellular carcinoma and their correlation with prognosis after immunotherapy

作　　者：胡宝茹[1] 尚乃舰[1] 高迪 Baoru Hu;Naijian Shang;Di Gao(Image Center,Harbin Medical University Cancer Hospital,Harbin 150000,China)

机构地区：[1]哈尔滨医科大学附属肿瘤医院影像中心,150000

出　　处：《中华消化病与影像杂志（电子版）》2023年第6期399-403,共5页Chinese Journal of Digestion and Medical Imageology(Electronic Edition)

摘　　要：目的基于中晚期肝细胞癌患者免疫治疗前后的磁共振动态增强(DCE-MRI)及弥散加权成像(DWI)表现,探讨DCE-MRI及DWI在中晚期肝细胞癌预后评估中的应用价值。方法收集2018年1月至2022年7月于哈尔滨医科大学附属肿瘤医院行免疫治疗的100例中晚期肝细胞癌患者的病历资料进行回顾性分析,免疫治疗前及治疗结束后均行DCE-MRI及DWI扫描,出院后进行定期随访,分析DCE-MRI及DWI表现与免疫治疗预后的相关性。结果100例患者随访期间死亡63例,生存37例,总生存率为37%,中位生存期为19个月。MRI特征表现:肿块边缘不规则;病灶边缘呈“快进快出”型强化;较大的病灶,往往信号不均匀,表明有坏死、液化、出血或钙化存在;DWI扩散受限。生存组与死亡组在肿瘤数目、肿块边缘、有无“快进快出”型强化、内部坏死及DWI扩散受限方面比较,差异均有统计学意义(P<0.05)。Cox多因素回归分析显示,肿块边缘不规则、有“快进快出”型强化、有内部坏死及DWI扩散受限是影响中晚期肝细胞癌患者免疫治疗预后生存的独立危险因素(P<0.05)。结论中晚期肝细胞癌的DCE-MRI及DWI表现中,肿块边缘不规则、有“快进快出”型强化、有内部坏死、DWI扩散受限与免疫治疗预后密切相关。Objective To explore the application value of dynamic contrast-enhanced MRI(DCE-MRI)and diffusion-weighted imaging(DWI)in prognosis evaluation in advanced hepatocellular carcinoma based on DCE-MRI and DWI findings before and after immunotherapy.Methods A retrospective analysis was performed on the case data of 100 patients with advanced hepatocellular carcinoma who underwent immunotherapy in Harbin Medical University Cancer Hospital between January 2018 and July 2022.All patients underwent DCE-MRI and DWI scans before and after immunotherapy,and they were regularly followed up after discharge.The correlation between DCE-MRI,DWI findings and prognosis after immunotherapy was analyzed.Results In the 100 patients during follow-up,there were 63 death cases and 37 survival cases.The overall survival rate and median survival time were 37%and 19 months,respectively.MRI findings:irregular edges in tumors,fast-in and fast-out enhancement in lesion edges.For larger lesions,there were often uneven signals,indicating necrosis,liquefaction,bleeding or calcification.There was limitation of DWI diffusion.There were significant differences in number of tumors,tumor edges,fast-in and fast-out enhancement,internal necrosis and limitation of DWI diffusion between the survival group and the death group(P<0.05).The results of Cox multivariate regression analysis showed that irregular edges in tumors,fast-in and fast-out enhancement,internal necrosis and limitation of DWI diffusion were independent risk factors of prognosis in patients with advanced hepatocellular carcinoma after immunotherapy(P<0.05).Conclusion In DCE-MRI and DWI findings from patients with advanced hepatocellular carcinoma,irregular edges in tumors,fast-in and fast-out enhancement,internal necrosis and limitation of DWI diffusion are closely related to prognosis after immunotherapy.

关 键 词：肝细胞癌 中晚期 磁共振 动态增强 弥散加权成像 免疫治疗 预后 

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