IVIM-DWI对TACE序贯氩氦刀治疗肝癌疗效的评估价值
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摘要
目的:探讨基于体素内不相干运动(IVIM)双指数模型肝脏多b值DWI扫描对TACE序贯氩氦刀冷冻治疗肝癌后肿瘤活性的评估价值。方法:随机选取符合纳入标准的肝癌患者40例作为研究对象,先行TACE治疗;并于TACE术后4周内行氩氦刀冷冻消融治疗。所有患者于氩氦刀冷冻消融治疗后1～4个月行肝脏IVIM-DWI、MRI多期动态增强扫描及CT增强扫描。由3位副高以上职称专家单独阅片,根据影像学表现将治疗后病灶分为坏死灶、残留灶、新发灶。临床通过病理学检查或长期随访确定坏死灶、残留灶、新发灶,通过影像学与临床判断对比,比较双指数IVIM模型DWI与单指数DWI、CT平扫加增强扫描对病灶性质的评估价值,以及扫描对肝癌TACE序贯氩氦刀治疗后活性评估的敏感度、特异度。结果:CT平扫加增强扫描、MRI平扫加增强扫描在肝癌TACE序贯氩氦刀治疗后病灶性质判断方面差异无统计学意义(P=0.076),但DWI与CT平扫加增强扫描在判断病灶性质方面差异有统计学意义(P=0.000)。肝癌介入治疗后坏死灶、残留灶、新发灶的ADC、Slow ADC及f值差异均有统计学意义(均P<0.05);残留灶与新发灶的ADC、Slow ADC值明显低于坏死灶(均P<0.01)。DWI对TACE序贯氩氦刀治疗肝癌后活性评估,当界值ADC=1.29×10~(-3)mm~2/s时,对肝癌活性诊断的敏感度及特异度分别达77.0%、90.8%;IVIM模型DWI当界值Slow ADC=1.18×10~(-3)mm~2/s时,对肝癌活性诊断的敏感度及特异度分别达82.5%、95.9%;CT增强扫描当CT净增值界值取14.40 HU时,对肝癌活性诊断的敏感度及特异度分别达75.0%、85.7%。结论:IVIM-DWI可对肝癌TACE序贯氩氦刀治疗后活性情况进行有效评估,且其评估肝癌TACE序贯氩氦刀治疗疗效价值明显优于单指数模型DWI及CT增强扫描。
Objective:To investigate the value of liver multi-b-value scanning based on IVIM model in the evaluation of tumor activity after liver cancer treatment with TACE sequential Argon-helium cryotherapy. Methods:Randomly selected 40 patients with liver cancer who met the inclusion criteria in our hospital's inpatient department as the research object,and received TACE treatment first,then cryoablation with Argon-helium knife was performed within 4 weeks after TACE. All patients underwent liver IVIM-DWI,multi-phase DCE-MRI and CT contrast-enhanced scan 1 ～4 months after cryoablation with Argon-helium knife. According to the imaging examinations,three doctors above the deputy senior title who were fixed in the department independently read the imaging and determined the characteristics of the lesions after treatment,which were divided into necrotic lesions,residual lesions and new lesions. Clinically,necrotic lesions,residual lesions and new lesions were determined by pathological examination or long-term follow-up. The diagnostic significance of dual-index IVIM model DWI imaging,single-index DWI imaging and CT enhancement on the evaluation of lesions properties were compared by imaging and clinical judgment. At the same time,the sensitivity and specificity of dual-index IVIM model DWI imaging,single-index DWI imaging and CT plain scan plus enhancement examination on the evaluation of liver cancer activity after TACE sequential Argon-helium cryoablation treatment were compared. Results:①There was no significant difference between CT plain scan and enhancement,MRI plain scan and enhancement in the number of lesions detected after TACE sequential Argon-helium cryoablation treatment for liver cancer(P=0.076),but the difference between DWI and CT plain scan and enhancement scan in judging the nature of lesions was statistically significant(P=0.000). ②The ADC,Slow ADC and F values of multi-b DWI imaging of necrotic lesions,residual lesions and new lesions were significantly different after interventional treatment of liver cancer. ADC and Slow ADC values of residual or new lesions were significantly lower than those of necrotic lesions(P< 0.01). ③DWI was used to evaluate the activity of TACE sequential argon-helium cryoablation in the treatment of liver cancer. When ADC =1.29 ×10~(-3) mm~2/s,the sensitivity and specificity of DWI in the diagnosis of liver cancer activity reached 77.0% and 90.8% respectively. The sensitivity and specificity of IVIM model DWI imaging were 82.5% and 95.9% respectively when the threshold Slow ADC=1.18×10~(-3) mm~2/s. The sensitivity and specificity of CT enhanced examination for the diagnosis of liver cancer activity reached 75.0% and 85.7% respectively when the net value-added threshold of CT was 14.40 HU.Conclusion:① IVIM-DWI scanning technology can effectively evaluate the activity of liver cancer after TACE sequential Argon-helium cryoablation treatment. ② The value of IVIM-DWI scanning technique in evaluating the curative effect of TACE sequential argon-helium knife treatment for liver cancer is obviously superior to DWI imaging and CT enhancement examination of single index model.
Objective:To investigate the value of liver multi-b-value scanning based on IVIM model in the evaluation of tumor activity after liver cancer treatment with TACE sequential Argon-helium cryotherapy. Methods:Randomly selected 40 patients with liver cancer who met the inclusion criteria in our hospital's inpatient department as the research object,and received TACE treatment first,then cryoablation with Argon-helium knife was performed within 4 weeks after TACE. All patients underwent liver IVIM-DWI,multi-phase DCE-MRI and CT contrast-enhanced scan 1 ～4 months after cryoablation with Argon-helium knife. According to the imaging examinations,three doctors above the deputy senior title who were fixed in the department independently read the imaging and determined the characteristics of the lesions after treatment,which were divided into necrotic lesions,residual lesions and new lesions. Clinically,necrotic lesions,residual lesions and new lesions were determined by pathological examination or long-term follow-up. The diagnostic significance of dual-index IVIM model DWI imaging,single-index DWI imaging and CT enhancement on the evaluation of lesions properties were compared by imaging and clinical judgment. At the same time,the sensitivity and specificity of dual-index IVIM model DWI imaging,single-index DWI imaging and CT plain scan plus enhancement examination on the evaluation of liver cancer activity after TACE sequential Argon-helium cryoablation treatment were compared. Results:①There was no significant difference between CT plain scan and enhancement,MRI plain scan and enhancement in the number of lesions detected after TACE sequential Argon-helium cryoablation treatment for liver cancer(P=0.076),but the difference between DWI and CT plain scan and enhancement scan in judging the nature of lesions was statistically significant(P=0.000). ②The ADC,Slow ADC and F values of multi-b DWI imaging of necrotic lesions,residual lesions and new lesions were significantly different after interventional treatment of liver cancer. ADC and Slow ADC values of residual or new lesions were significantly lower than those of necrotic lesions(P< 0.01). ③DWI was used to evaluate the activity of TACE sequential argon-helium cryoablation in the treatment of liver cancer. When ADC =1.29 ×10~(-3) mm~2/s,the sensitivity and specificity of DWI in the diagnosis of liver cancer activity reached 77.0% and 90.8% respectively. The sensitivity and specificity of IVIM model DWI imaging were 82.5% and 95.9% respectively when the threshold Slow ADC=1.18×10~(-3) mm~2/s. The sensitivity and specificity of CT enhanced examination for the diagnosis of liver cancer activity reached 75.0% and 85.7% respectively when the net value-added threshold of CT was 14.40 HU.Conclusion:① IVIM-DWI scanning technology can effectively evaluate the activity of liver cancer after TACE sequential Argon-helium cryoablation treatment. ② The value of IVIM-DWI scanning technique in evaluating the curative effect of TACE sequential argon-helium knife treatment for liver cancer is obviously superior to DWI imaging and CT enhancement examination of single index model.
引文
[1]国家卫生计生委办公厅.原发性肝癌诊疗规范(2017年版)[S/OL].2017-06-02.http://www.moh.gov.cn/yzygj/s7659/201706/80abf02a86c048fcb130e5e298f7aeee.shtml.
[2]程瑞文,邓梨平,李平,等. TACE联合氩氦刀冷冻消融术治疗原发性肝癌后血小板变化观察[J].中国中西医结合影像学杂志,2016,14(2):206-208.
[3]庄炜钊,黄晨,姬智艳,等. TACE联合氩氦刀冷冻消融治疗中晚期肝癌的疗效分析[J].医学影像学杂志,2016,26(12):2247-2250.
[4]中国抗癌协会肝癌专业委员会,中华医学会肝病学分会肝癌学组,中国抗癌协会病理专业委员会,等.原发性肝癌规范化病理诊断指南(2015版)[J].临床与实验病理学杂志,2015,31(3):241-246.
[5]孙燕.内科肿瘤学[M].北京:人民卫生出版社,2001:648-649.
[6]石明,陈继安,林小军,等.肝动脉栓塞化疗不同化疗方案治疗不可切除肝癌的前瞻性随机对照研究[J].中国肿瘤临床,2009,36(1):9-13.
[7] Woo S,Lee JM,Yoon JH,et al. Intravoxel incoherent motion diffusion-weighted MR imaging of hepatocellular carcinoma:correlation with enhancement degree and histologic Grade[J]. Radiology,2014,270:758-767.
[8]叶伟东,纪建松,涂建飞,等.氩氦刀冷冻消融联合肝动脉栓塞化疗术治疗中晚期肝癌的疗效分析[J].介入放射学杂志,2015,24(5):392-395.
[9]庄广义,任伟新,迪里木拉提·巴吾冬,等.原发性肝癌TACE术后CT和DSA随访对比分析[J].介入放射学杂志,2009,18(12):942-945.
[10]罗泽.多层螺旋CT增强扫描对肝脏占位性病变的诊断价值[J].临床医学,2018,38(8):56-58.
[11] Yu JS,Kim JH,Chung JJ,et al. Added value of diffusion-weighted imaging in the MRI assessment of perilesional tumor recurrence after chemoembolization of hepatocellular carcinomas[J].J MagnReson Imaging,2009,30:153-160.
[12]蒋智,张建淮,屠道远.肝癌肿瘤标志物的研究进展[J].中国临床研究,2018,31(2):270-273.
[13]肖安岭,王海涛,张芃芃,等.磁共振动态增强联合弥散加权成像对原发性肝癌的诊断及其临床价值研究[J].临床和实验医学杂志,2018,17(14):1526-1529.
[14]林静,张贤龙,游建,等.磁共振成像对肝细胞癌患者经导管动脉化疗栓塞联合射频消融的疗效及预后评估价值[J].肝脏,2018,23(6):522-524.
[15]宋达.磁共振功能成像对肝癌介入术后评估的进展[J].影像研究与医学应用,2018,2(12):45-46.
[16]侯毅斌,王忠富,施裕新,等.磁共振弥散加权成像联合动态增强在评估肝癌TACE术后病灶残留及随访中的应用价值[J].中国CT和MRI杂志,2018,16(1):108-110.
[17]朱正,赵心明,周纯武,等.体素内不相干运动扩散加权成像在肝癌介入治疗预后中的价值[J].肿瘤影像学,2018,27(2):82-87.
[18]王倩倩,刘新疆. IVIM-DWI在肝脏局灶性病变中的应用进展[J].磁共振成像,2018,9(4):312-315.
[19]丁士申.磁共振扩散加权成像对肝癌的诊断及鉴别诊断作用[J].影像研究与医学应用,2018,2(8):89-90.
[20]凌公豪,范晨虹,龙清云,等.体素内不相干运动扩散加权成像定量参数在肝脏良恶性病变诊断中的价值[J].临床放射学杂志,2018,37(3):536-540.
[2]程瑞文,邓梨平,李平,等. TACE联合氩氦刀冷冻消融术治疗原发性肝癌后血小板变化观察[J].中国中西医结合影像学杂志,2016,14(2):206-208.
[3]庄炜钊,黄晨,姬智艳,等. TACE联合氩氦刀冷冻消融治疗中晚期肝癌的疗效分析[J].医学影像学杂志,2016,26(12):2247-2250.
[4]中国抗癌协会肝癌专业委员会,中华医学会肝病学分会肝癌学组,中国抗癌协会病理专业委员会,等.原发性肝癌规范化病理诊断指南(2015版)[J].临床与实验病理学杂志,2015,31(3):241-246.
[5]孙燕.内科肿瘤学[M].北京:人民卫生出版社,2001:648-649.
[6]石明,陈继安,林小军,等.肝动脉栓塞化疗不同化疗方案治疗不可切除肝癌的前瞻性随机对照研究[J].中国肿瘤临床,2009,36(1):9-13.
[7] Woo S,Lee JM,Yoon JH,et al. Intravoxel incoherent motion diffusion-weighted MR imaging of hepatocellular carcinoma:correlation with enhancement degree and histologic Grade[J]. Radiology,2014,270:758-767.
[8]叶伟东,纪建松,涂建飞,等.氩氦刀冷冻消融联合肝动脉栓塞化疗术治疗中晚期肝癌的疗效分析[J].介入放射学杂志,2015,24(5):392-395.
[9]庄广义,任伟新,迪里木拉提·巴吾冬,等.原发性肝癌TACE术后CT和DSA随访对比分析[J].介入放射学杂志,2009,18(12):942-945.
[10]罗泽.多层螺旋CT增强扫描对肝脏占位性病变的诊断价值[J].临床医学,2018,38(8):56-58.
[11] Yu JS,Kim JH,Chung JJ,et al. Added value of diffusion-weighted imaging in the MRI assessment of perilesional tumor recurrence after chemoembolization of hepatocellular carcinomas[J].J MagnReson Imaging,2009,30:153-160.
[12]蒋智,张建淮,屠道远.肝癌肿瘤标志物的研究进展[J].中国临床研究,2018,31(2):270-273.
[13]肖安岭,王海涛,张芃芃,等.磁共振动态增强联合弥散加权成像对原发性肝癌的诊断及其临床价值研究[J].临床和实验医学杂志,2018,17(14):1526-1529.
[14]林静,张贤龙,游建,等.磁共振成像对肝细胞癌患者经导管动脉化疗栓塞联合射频消融的疗效及预后评估价值[J].肝脏,2018,23(6):522-524.
[15]宋达.磁共振功能成像对肝癌介入术后评估的进展[J].影像研究与医学应用,2018,2(12):45-46.
[16]侯毅斌,王忠富,施裕新,等.磁共振弥散加权成像联合动态增强在评估肝癌TACE术后病灶残留及随访中的应用价值[J].中国CT和MRI杂志,2018,16(1):108-110.
[17]朱正,赵心明,周纯武,等.体素内不相干运动扩散加权成像在肝癌介入治疗预后中的价值[J].肿瘤影像学,2018,27(2):82-87.
[18]王倩倩,刘新疆. IVIM-DWI在肝脏局灶性病变中的应用进展[J].磁共振成像,2018,9(4):312-315.
[19]丁士申.磁共振扩散加权成像对肝癌的诊断及鉴别诊断作用[J].影像研究与医学应用,2018,2(8):89-90.
[20]凌公豪,范晨虹,龙清云,等.体素内不相干运动扩散加权成像定量参数在肝脏良恶性病变诊断中的价值[J].临床放射学杂志,2018,37(3):536-540.