磁共振扩散加权成像对肝细胞癌化疗栓塞术后疗效的随访价值
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摘要
目的探讨磁共振扩散加权成像(DWI)对肝细胞癌(HCC)经导管肝动脉化疗栓塞术(TACE)治疗后疗效评估的应用价值。方法选取安徽省立医院2014年1月至2016年12月收治的经临床或病理检查确诊的52例HCC患者为研究对象,所有患者均经1~3次TACE治疗,并于TACE术前、术后4~6周行上腹部磁共振平扫及DWI检查,术后4个月行磁共振增强扫描,上述检查均在1周内完成。依据实体肿瘤疗效评估标准(mRECIST),将病例分为稳定组和进展组,分析TACE术前、术后病灶的坏死、复发转移情况以及表观弥散系数(ADC)值;采用受试者工作特征曲线(ROC)确定鉴别稳定组和进展组的诊断效能以及ADC的最佳截断值。结果 52例HCC患者术前共计检出68个病灶;参照mRECIST标准,评价为稳定病例20例,进展病例32例。术前病灶以稍长T1和T2信号为主,DWI序列上呈高信号,ADC图上呈低信号; TACE术后,肿瘤坏死区呈等或稍长T1、T2信号,DWI序列上呈等或稍低信号。进展组于T1WI和T2WI序列上信号表现多样,DWI序列上呈不均性高信号;稳定组和进展组术前肿瘤病灶的ADC值差异无统计学意义(P> 0. 05),稳定组术后ADC值较术前升高(P <0. 05),其手术前后ADC的增加值高于进展组(P <0. 05)。ROC分析提示:鉴别稳定组和进展组ADC的最佳截断值为1. 28×10-3mm2/s,此时曲线下面积为0. 773 (P <0. 05)、灵敏度为76. 3%、特异度为68. 9%。结论 DWI扫描能够及时、客观的评估HCC患者化疗栓塞术后疗效,具有较高的随访价值。
Objective To investigate the clinical application of magnetic resonance diffusion weighted imaging( DWI) to assess therapeutic efficacy for patients with hepatocellular carcinoma( HCC) treated by transcatheter arterial chemoembolization( TACE). Methods Fifty-two HCC patients with one to three times TACE treatments confirmed clinically or pathologically in our hospital from Jan 2014 to Dec2016 were enrolled as subjects. All patients underwent plain-enhanced magnetic resonance imaging( MRI) and DWI scan before and four to six weeks after TACE,the contrast-enhanced MRI was performed four months after surgery,and all work was completed within one week.The cases were divided into stable group and progress group based on modified response evaluation criteria in solid tumors( mRECIST). The pre-TACE and post-TACE active components,necrosis,recurrence,metastasis and apparent diffusion coefficient( ADC) of HCC were qualitatively analyzed. The diagnostic value and the optimal cut off point of ADC in differentiating two groups were determined by receiver operating characteristic curve( ROC). Results A total of 68 lesions were found in 52 HCC patients before TACE,among which 20 cases were stable and 32 cases were advanced on the basis of the mRECIST. The main signal of HCC lesions was long T1 and T2 signal on DWI images and low signal on ADC maps before treatment; however,after TACE,the ischemic necrosis area of tumor presented equal or long signals on T1 WI and T2 WI with equal or low signal on DWI sequence,and the active lesion showed diverse signal on T1 WI and T2 WI as well as inhomogeneous high signal on DWI images. There was no significant difference in preoperative ADC value of tumor between the progress and stable groups( P > 0. 05); however,the postoperative ADC values of stable group were higher( P < 0. 05),which had a superior growth to progress group between before and after treatment( P < 0. 05). The result of ROC indicated that 1. 28 × 10-3 mm2/s was the cut off point of ADC in differentiating two groups with the 76. 3% sensitivity,68. 9% specificity and 0. 773 area under the curve( P < 0. 05). Conclusion DWI scan can predict the postoperative efficacy of HCC patients,which is of great application value for the further treatment plan.
Objective To investigate the clinical application of magnetic resonance diffusion weighted imaging( DWI) to assess therapeutic efficacy for patients with hepatocellular carcinoma( HCC) treated by transcatheter arterial chemoembolization( TACE). Methods Fifty-two HCC patients with one to three times TACE treatments confirmed clinically or pathologically in our hospital from Jan 2014 to Dec2016 were enrolled as subjects. All patients underwent plain-enhanced magnetic resonance imaging( MRI) and DWI scan before and four to six weeks after TACE,the contrast-enhanced MRI was performed four months after surgery,and all work was completed within one week.The cases were divided into stable group and progress group based on modified response evaluation criteria in solid tumors( mRECIST). The pre-TACE and post-TACE active components,necrosis,recurrence,metastasis and apparent diffusion coefficient( ADC) of HCC were qualitatively analyzed. The diagnostic value and the optimal cut off point of ADC in differentiating two groups were determined by receiver operating characteristic curve( ROC). Results A total of 68 lesions were found in 52 HCC patients before TACE,among which 20 cases were stable and 32 cases were advanced on the basis of the mRECIST. The main signal of HCC lesions was long T1 and T2 signal on DWI images and low signal on ADC maps before treatment; however,after TACE,the ischemic necrosis area of tumor presented equal or long signals on T1 WI and T2 WI with equal or low signal on DWI sequence,and the active lesion showed diverse signal on T1 WI and T2 WI as well as inhomogeneous high signal on DWI images. There was no significant difference in preoperative ADC value of tumor between the progress and stable groups( P > 0. 05); however,the postoperative ADC values of stable group were higher( P < 0. 05),which had a superior growth to progress group between before and after treatment( P < 0. 05). The result of ROC indicated that 1. 28 × 10-3 mm2/s was the cut off point of ADC in differentiating two groups with the 76. 3% sensitivity,68. 9% specificity and 0. 773 area under the curve( P < 0. 05). Conclusion DWI scan can predict the postoperative efficacy of HCC patients,which is of great application value for the further treatment plan.
引文
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[12]于胜峰,邓雪飞,胡东,等.扩散加权成像对原发性中枢神经系统淋巴瘤放疗疗效的预测价值[J].安徽医学,2017,38(6):705-708.
[13]岳新建. DWI对晚期肝细胞肝癌患者分子靶向药物治疗的疗效评估[J].中国中西医结合影像学杂志,2016,14(5):514-516.
[14] MANNELLI L,KIM S,HAJDU C H,et al. Serial diffusionweighted MRI in patients with hepatocellular carcinoma:prediction and assessment of response to transarterial chemoembolization. preliminary experience[J]. Eur J Radiol,2013,82(4):577-582.
[15]高回青,郁义星,胡春洪,等.弥散加权成像联合普美显磁共振成像在肝癌TACE术后疗效评估中的应用[J].介入放射学杂志,2016,25(9):774-778.
[16]晏耀文,饶圣祥,俞梦勇.扩散加权成像在预测肝细胞肝癌微血管浸润的价值[J].临床放射学杂志,2016,35(1):93-95.
[2] MLYNARSKY L,MENACHEM Y,SHIBOLETO. Treatment of hepatocellular carcinoma:steps forward but still a long way to go[J]. World J Hepatol,2015,7(3):566-574.
[3] GATTA G,BOTTA L,ROSSI S,et al. Childhood cancer survival in Europe 1999-2007:results of EUROCARE-5-a population-based study[J]. Lancet Oncol,2014,15(1):35-47.
[4]付静静,王凇,杨薇.射频消融联合肝动脉化疗栓塞治疗肝癌的应用[J].介入放射学杂志,2016,25(3):268-271.
[5]冯静. DWI联合常规磁共振成像在原发性肝癌治疗后随访中应用研究[J].中国CT和MRI杂志,2017,15(5):100-102.
[6] VANDECAVEYE V,MICHIELSEN K,DE KEYZER F,et al.Chemoembolization for hepatocellular carcinoma:1-month response determined with apparent diffusion coefficient is an independent predictor of outcome[J]. Radiology,2014,270(3):747-757.
[7]李爽,吕维富,董金斌,等.肝细胞癌化疗栓塞术后MSCT与MRI随访的对比分析[J].安徽医科大学学报,2014,49(3):389-401.
[8]张梅,徐雪房,李艳明,等. CT联合血清指标对不同组织分化程度肝细胞肝癌患者TACE术后的多元分析评价[J].滨州医学院学报,2014,37(5):327-330.
[9]何川东,周莹,黄丹,等.宝石CT能谱成像在肝癌经皮肝动脉化疗栓塞术后疗效评估及随访中的应用价值[J].介入放射学杂志,2016,25(1):34-39.
[10] KANEMURA S,KURIBAYASHI K,FUNAGUCHI N,et al.Metabolic response assessment with 18F-FDG-PET/CT is superior to modified RECIST for the evaluation of response to platinum-based doublet chemotherapy in malignant pleuralmesothelioma[J]. Eur J Radiol,2017,86:92-98.
[11] XU Y,XIAO A,YANG J,et al. Assessment of lipiodol deposition and residual cancer for hepatocellular carcinoma after transcatheter arterial chemoembolization via iodine-based material decomposition images with spectral computed tomography imaging:a preliminary study[J]. Iran J Radiol,2015,12(4):e26009.
[12]于胜峰,邓雪飞,胡东,等.扩散加权成像对原发性中枢神经系统淋巴瘤放疗疗效的预测价值[J].安徽医学,2017,38(6):705-708.
[13]岳新建. DWI对晚期肝细胞肝癌患者分子靶向药物治疗的疗效评估[J].中国中西医结合影像学杂志,2016,14(5):514-516.
[14] MANNELLI L,KIM S,HAJDU C H,et al. Serial diffusionweighted MRI in patients with hepatocellular carcinoma:prediction and assessment of response to transarterial chemoembolization. preliminary experience[J]. Eur J Radiol,2013,82(4):577-582.
[15]高回青,郁义星,胡春洪,等.弥散加权成像联合普美显磁共振成像在肝癌TACE术后疗效评估中的应用[J].介入放射学杂志,2016,25(9):774-778.
[16]晏耀文,饶圣祥,俞梦勇.扩散加权成像在预测肝细胞肝癌微血管浸润的价值[J].临床放射学杂志,2016,35(1):93-95.