普美显肝胆期甜甜圈结节MRI表现联合DCE-MRI灌注定量参数评估肝细胞癌经肝动脉化疗栓塞疗效的价值  

The value of combining the MRI manifestations of pumeixian liver bile stage donut nodules with DCE-MRI perfusion quantitative parameters in evaluating the efficacy of transcatheter arterial chemoembolization for hepatocellular carcinoma

作　　者：李云华[1] 高鑫阳 LI Yun-hua;GAO Xin-yang(Department of Radiology,Changzhou Third People's Hospital,Jiangsu 213001,China)

机构地区：[1]常州市第三人民医院放射科,江苏213001

出　　处：《肝脏》2025年第2期216-221,共6页Chinese Hepatology

基　　金：江苏省自然科学基金青年基金项目(BK20200032)。

摘　　要：目的探究普美显肝胆期甜甜圈结节磁共振扫描(MRI)表现联合MRI动态增强扫描(DCE-MRI)灌注定量参数评估肝细胞癌(HCC)经肝动脉化疗栓塞(TACE)疗效的价值。方法回顾性分析2018年1月—2023年1月常州市第三人民医院收诊的86例行TACE治疗的HCC患者的病历资料。记录TACE治疗前普美显肝胆期甜甜圈结节MRI表现及DCE-MRI灌注定量参数[病灶最大层面血管通透性常数(Kt)、血液回流常数(Kep)、血管外细胞间隙容积百分比(Ve)]。TACE治疗后参考实体瘤评价标准1.1(RECIST 1.1)评估疗效,并分为稳定组、进展组。分析HCC患者TACE疗效的影响因素,评估普美显肝胆期甜甜圈结节MRI表现、DCE-MRI灌注定量参数对HCC患者TACE疗效的预测效能。结果86例行TACE治疗的HCC患者中进展46例(53.49%),稳定40例(46.51%)。TACE治疗前,MRI肝胆期扫描结果显示,86例HCC患者中肝胆期甜甜圈结节表现35例(40.70%)且动脉期均呈高增强信号,低信号表现45例(52.33%),高信号表现6例(6.98%)。普美显肝胆期甜甜圈结节MRI表现预测TACE疗效的灵敏度为76.09%、特异度为100.00%、阳性预测值为100.00%、阴性预测值为78.43%。进展组、稳定组患者的△Kt分别为0.22±0.07、0.31±0.09,△Kep分别为0.57±0.12、0.39±0.10。进展组患者的△Kt低于稳定组,△Kep高于稳定组(P<0.05)。两组△Ve比较差异无统计学意义(P>0.05)。进展组患者的总胆红素(TBil)、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)高于稳定组(P<0.05)。TBil、ALT、AST、△Kt、△Kep及普美显肝胆期甜甜圈结节表现是HCC进展的危险因素(P<0.05)。普美显肝胆期甜甜圈结节MRI表现、△Kt、△Kep单一及联合预测HCC进展的AUC分别为0.880、0.750、0.748、0.887。结论普美显肝胆期甜甜圈结节MRI表现与DCE-MRI灌注中Kt及Kep变化与HCC患者TACE的治疗反应性有关,可用于预测疗效。Objective To explore the value of magnetic resonance imaging(MRI)combined with dynamic contrast-enhanced MRI(DCE-MRI)perfusion quantitative parameters in evaluating the efficacy of transcatheter arterial chemoembolization(TACE)in hepatocellular carcinoma(HCC)during the hepatobiliary phase.Methods Retrospective analysis of the medical records of 86 HCC patients treated with TACE at Changzhou Third People′s Hospital between January 2018 and January 2023.Record the MRI manifestations and DCE-MRI perfusion quantitative parameters of the hepatic and biliary phase donut nodules before transcatheter hepatic arterial chemoembolization treatment,including the vascular permeability constant(Kt),blood reflux constant(Kep),and percentage of extracellular space volume(Ve)at the maximum level of the lesion.After hepatic artery chemoembolization treatment,the efficacy was evaluated according to the solid tumor evaluation standard 1.1(RECIST 1.1)and divided into stable group and progressive group.Analyze the influencing factors of the efficacy of TACE in HCC patients.Evaluate the predictive efficacy of MRI manifestations of hepatic biliary doughnut nodules and DCE-MRI perfusion quantitative parameters in predicting the efficacy of TACE in HCC patients.Results Among 86 HCC patients treated with hepatic artery chemoembolization,46(53.49%)progressed and 40(46.51%)remained stable.Before undergoing hepatic arterial chemoembolization treatment,the MRI liver biliary phase scan results showed that among 86 HCC patients,35(40.70%)had hepatic biliary doughnut nodules,and the arterial phase showed high enhanced signal,with 45(52.33%)showing low signal and 6(6.98%)showing high signal.The sensitivity,specificity,positive predictive value,and negative predictive value of Pu Mei Xian′s hepatic biliary phase donut nodule MRI in predicting the efficacy of TACE were 76.09%,100.00%,100.00%,and 78.43%,respectively.TheΔKt of patients in the progression group and stable group were(0.22±0.07)and(0.31±0.09),respectively,withΔKep of(0.57±0.12)a

关 键 词：肝细胞癌 经肝动脉化疗栓塞 肝胆期 结节信号强度 磁共振动态增强扫描 

分 类 号：R735.7[医药卫生—肿瘤]