MR扩散加权成像序列表观扩散系数值变化预测原发性肝细胞癌射频消融术预后的价值  

Value of apparent diffusion coefficient value changes of MR diffusion weighted imaging in predicting the prognosis of primary hepatocellular carcinoma treated with radiofrequency ablation

作　　者：潘宝燕 李辉 亓立勇 管然祺 PAN Baoyan;LI Hui;QI Liyong;GUAN Ranqi(Department of Radiology,the Second Children&Women’s Healthcare of Ji’nan City,Ji’nan 250013,China;Department of Radiology,Ji’nan Integrated Traditional Chinese and Western Medicine Hospital,Ji’nan 250013,China)

机构地区：[1]济南市第二妇幼保健院放射科,山东济南250013 [2]济南市中西医结合医院放射科,山东济南250013

出　　处：《实用放射学杂志》2024年第4期577-580,585,共5页Journal of Practical Radiology

基　　金：山东省医药卫生科技发展计划项目(2103WSA12001)。

摘　　要：目的探讨磁共振扩散加权成像(MR-DWI)序列表观扩散系数(ADC)值预测原发性肝细胞癌(HCC)射频消融术(RFA)预后的价值。方法选取178例HCC患者进行前瞻性研究,所有患者均行RFA治疗,治疗后随访1年。RFA前、RFA后1个月行MR-DWI检查,计算ADC值变化量。比较不同临床病理参数患者癌灶ADC值变化量,分析影响HCC患者RFA预后的因素,分析MR-DWI序列ADC值变化量预测HCC患者RFA预后的价值。结果高甲胎蛋白、巴塞罗那临床肝癌(BCLC)分期C期、低分化患者的ADC值变化量分别低于低甲胎蛋白、BCLC分期B期、中高分化患者(P<0.05)。6例失访,剩余172例患者中120例生存。Cox回归分析显示ADC值变化量、肿瘤分期、分化程度情况是影响HCC患者RFA预后的独立因素(P<0.05)。受试者工作特征(ROC)曲线分析结果显示,MR-DWI序列ADC值变化量预测HCC患者RFA预后的最佳截断点、灵敏度、特异度、曲线下面积(AUC)分别为0.42×10^(-3)mm^(2)/s、75.00%、78.33%、0.801。ADC值高变化量组(>0.42)死亡16例,低变化量组(≤0.42)死亡36例,ADC值高变化量组总存活曲线优于低变化量组(P<0.05)。结论HCC患者短期RFA治疗前后MR-DWI序列ADC值变化量与患者病理、预后有关,ADC值变化量预测RFA预后效能良好,ADC值变化量低者预后不良风险高。Objective To explore the value of apparent diffusion coefficient(ADC)values of magnetic resonance diffusion weighted imaging(MR-DWI)in predicting the prognosis of primary hepatocellular carcinoma(HCC)treated by radiofrequency ablation(RFA).Methods A prospective study was conducted on 178 patients with HCC.All patients were treated with RFA and followed up for 1 year after treatment.MR-DWI was performed before RFA and one month after RFA,and the changes in ADC value were calculated.These changes of the cancer in patients with different clinicopathological parameters were compared.The factors affecting the prognosis of HCC patients with RFA,and the value of ADC value changes in predicting the prognosis were analyzed.Results The changes of ADC values in patients with high alpha-fetoprotein,Barcelona clinic live cancer(BCLC)stage C,and poorly differentiated were lower than those in patients with low alpha-fetoprotein,BCLC stage B,and moderately well-differentiated(P<0.05).Six cases were lost to follow-up,and 120 of the remaining 172 patients survived.Cox regression analysis showed that the changes in ADC value,tumor stage and degree of differentiation were independent factors affecting the prognosis of HCC patients with RFA(P<0.05).Receiver operating characteristic(ROC)curve results showed that the best cut-off point,sensitivity,specificity and area under the curve(AUC)of ADC value change in predicting the prognosis of HCC patients with RFA were 0.42×10^(-3)mm^(2)/s,75.00%,78.33%and 0.801.There were 16 deaths in the high change group of ADC value(>0.42)and 36 deaths in the low change group(≤0.42).The overall survival curve of the high change group of ADC value was better than that of the low change group(P<0.05).Conclusion The change in ADC value of MR-DWI sequence before and after short-term RFA treatment in HCC patients is related to the patient’s pathology and prognosis,with a good predictive effect.The low change in ADC value has a higher risk of poor prognosis.

关 键 词：原发性肝细胞癌 射频消融术 磁共振扩散加权成像 表观扩散系数 预后 

分 类 号：R735.7[医药卫生—肿瘤] R730.59[医药卫生—临床医学] R445.2