体素内不相干运动-弥散加权成像评价不同栓塞材料经动脉化疗栓塞治疗肝细胞癌效果及预后  

The application of IVIM-DWI in evaluating the efficacy and prognosis of TACE using differentembolization materials for hepatocellular carcinoma

作　　者：管清龙 陈海波 刘成龙 曹耿飞 张海潇[3] 崔传宝 GUAN Qinglong;CHNE Haibo;LIU Chenglong;CAO Gengfei;ZHANG Haixiao;CUI Chuanbao(Department of Vascular Surgery,Second Affiliated Hospital of Shandong First Medical University,Taian,Shandong Province 271000,China)

机构地区：[1]山东第一医科大学第二附属医院血管外科,山东泰安271000 [2]山东第一医科大学第二附属医院影像科,山东泰安271000 [3]新疆医科大学第一附属医院介入科,山东泰安271000 [4]泰山学院

出　　处：《介入放射学杂志》2024年第2期140-145,共6页Journal of Interventional Radiology

基　　金：山东省自然科学基金(ZR2021QH175);泰安市科技创新发展项目(2021NS154)。

摘　　要：目的 探讨MR体素内不相干运动(IVIM)-弥散加权成像(DWI)评价经导管动脉化疗栓塞术(TACE)治疗肝细胞癌(HCC)效果及预后。方法 选取2019年6月30日至2022年12月30日山东第一医科大学第二附属医院和新疆医科大学第一附属医院采用TACE治疗的84例不能手术切除HCC患者临床资料。TACE术中根据患者病情使用不同栓塞材料,术前及术后1、6、12个月行IVIM-DWI检查。根据IVIM-DWI序列设定的固定b值,分析不同栓塞材料下单指数模型表观弥散系数(ADC)值和双指数模型纯弥散系数(D值)、伪弥散系数(D*值)和灌注分数(f值)。根据改良实体瘤疗效评价标准(mRECIST)及不同栓塞治疗材料将患者分为稳定组和进展组,对比分析ADC值、D值、D*及f值变化。采用多因素Cox回归分析年龄、肝功能Child-Pugh分级、甲胎蛋白(AFP)含量、肿瘤大小等4个临床参数和治疗前后ADC值、D值、D*值、f值共8个功能学定量指标参数,确定具有预后预测价值的IVIM参数。通过受试者工作特征曲线(ROC)分析IVIM参数对预测值的诊断价值和Cut-off值。结果 治疗后载药微球组ADC值显著高于碘化油组,载药微球组、碘化油组D*值显著低于PVA颗粒组,载药微球组f值显著低于碘化油组(均P<0.01)。稳定组中载药微球组疗效明显优于碘化油组和PVA颗粒组,进展组中碘化油组比载药微球组和PVA颗粒组更易出现疾病进展。稳定组治疗前f值显著高于进展组(P=0.005),治疗后ADC值显著高于进展组(P=0.029)。ROC分析显示,载药微球组、碘化油组、PVA颗粒组分别中位随访30、19、26个月,总平均生存时间为25个月,总生存时间差异有统计学意义(P<0.01)。多因素Cox回归分析显示,治疗前D值(AUC 0.878)、D*值(AUC 0.554)及治疗后D值(AUC 0.791)、D*值(AUC 0.552)、f值(AUC 0.467)是TACE近期疗效的独立影响因素(均P<0.05),治疗前后D值诊断效能更高,治疗前D值<0.505×10-3mm2/s、治疗后D值<0.785×Objective To discuss the clinical application of intravoxel incoherent motion-diffusion weighted imaging(IVIM-DWI) in evaluating the efficacy and prognosis of transcatheter arterial chemoembolization(TACE)using different embolization materials for the treatment of hepatocellular carcinoma(HCC).Methods The clinical data of a total of 84 patients with inoperable HCC,who received TACE treatment at the Second Affiliated Hospital of Shandong First Medical University of China and the First Affiliated Hospital of Xinjiang Medical University of China between June 30,2019 and December 30,2022,were collected.According to the patient's condition,different embolization materials were used during TACE.IVIM-DWI check-up was performed before treatment as well as at one,6,12 months after treatment.Based on the fixed b-value set by IVIM-DWI sequence,the ADC value of the order index model for different embolization materials and the pure diffusion coefficient of double exponential model (D value),the pseudo-diffusion coefficient (D*value) and perfusion fraction(f value) were analyzed.According to modified Response Evaluation Criteria in Solid Tumors(mRECIST) and the embolization material used,the patients were divided into the stable group and progression group,and the changes in the ADC value,D value,D*value and f value were compared between the two groups.Multivariate Cox regression analysis was used to analyze the four clinical parameters (including age,ChildPugh grade,AFP level and tumor size) and the eight functional quantitative indexes (including preoperative and postoperative ADC value,D value,D*value and f value) so as to determine the IVIM parameters with prognostic predictive value.Receiver operating characteristic (ROC) was adopted to analyze the diagnostic value and cut-off value of IVIM parameters with predictive value.Results After treatment,the ADC value of drug-loaded microspheres group(n=36) was significantly higher than that of iodized oil group(n=27),the D*value of drug-loaded microspheres group and iodized oil

关 键 词：肝细胞癌 体素内不相干运动 经导管动脉化疗栓塞术 弥散加权成像 磁共振成像 

分 类 号：R735.7[医药卫生—肿瘤]