磁共振扩散加权成像表观扩散系数评估肝癌患者TACE疗效
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摘要
目的:观察分析磁共振扩散加权成像表观扩散系数(ADC)对肝癌患者经导管肝动脉栓塞术(TACE)后疗效的评估价值。方法:选取肝细胞癌患者52例,病灶共计79个,共计进行TACE161次,分别于治疗前、治疗后、治疗后1个月及治疗后3个月进行磁共振扩散加权成像,在各个阶段测定肝脏正常组织和肿瘤组织的ADC值,疗效评定标准分级为完全缓解(优良)、部分缓解(一般)和进展(差)。将所有患者分为优良组、一般组和进展组,对比分析患者治疗前后及随访中ADC值的变化情况。结果:治疗后肿瘤病灶ADC值为(1.48±0.16)×10~(-3)mm~2/s,显著高于正常肝组织的(1.22±0.15)×10~(-3)mm~2/s。治疗后肿瘤组织区域ADC值升高程度优良组最明显,一般组次之,进展组最小,优良组与一般组组间治疗前后肿瘤组织区域ADC值比较有统计学差异(P<0.05),组内比较无统计学差异(P>0.05)。治疗后1个月和3个月各组之间两两比较差异均有统计学意义(P<0.05),3组比较差异有统计学意义(P<0.05)。结论:ADC对肝癌患者TACE后疗效的评估有较好的参考价值。
Objective To analyze the value of apparent diffusion coefficient(ADC) values of magnetic resonance diffusion-weighted imaging(MR-DWI) in the evaluation of the therapeutic effect of transhepatic arterial chemoembolization(TACE) for liver cancer.Methods A total of 52 patients with hepatocellular carcinoma were enrolled in this study, with a total of 79 lesions and a total of161 TACE treatments. MR-DWI was performed at different times(before treatment, after treatment, 1 month after treatment and 3 months after treatment). The ADC values of normal liver tissues and tumor tissues were measured before and after treatment.According to the efficacy evaluation criteria, the patients were classified into 3 groups, namely complete remission group, partial remission group and progression group. The changes of ADC values before and after treatment and during follow-up were analyzed. Results The ADC value of tumor lesions after treatment was(1.48±0.16)×10~(-3) mm~2/s, significantly higher than(1.22±0.15)×10~(-3) mm~2/s of normal liver tissues. After treatment, the increase of ADC value of the tumor tissue area was most obvious in complete remission group, followed by partial remission group and progression group. Statistical differences were found in the ADC value of tumor tissue area between complete remission group and partial remission group before and after treatment(P<0.05),while no statistical difference was found in the intra-group comparison(P>0.05). There were significant differences between any two groups at 1 month and 3 months after treatment(P<0.05), and the differences in the comparison among 3 groups has statistical significance(P<0.05). Conclusion The ADC value of magnetic resonance diffusion-weighted imaging provides a good reference value for the evaluation of chemotherapeutic efficacy of TACE in patients with liver cancer.
Objective To analyze the value of apparent diffusion coefficient(ADC) values of magnetic resonance diffusion-weighted imaging(MR-DWI) in the evaluation of the therapeutic effect of transhepatic arterial chemoembolization(TACE) for liver cancer.Methods A total of 52 patients with hepatocellular carcinoma were enrolled in this study, with a total of 79 lesions and a total of161 TACE treatments. MR-DWI was performed at different times(before treatment, after treatment, 1 month after treatment and 3 months after treatment). The ADC values of normal liver tissues and tumor tissues were measured before and after treatment.According to the efficacy evaluation criteria, the patients were classified into 3 groups, namely complete remission group, partial remission group and progression group. The changes of ADC values before and after treatment and during follow-up were analyzed. Results The ADC value of tumor lesions after treatment was(1.48±0.16)×10~(-3) mm~2/s, significantly higher than(1.22±0.15)×10~(-3) mm~2/s of normal liver tissues. After treatment, the increase of ADC value of the tumor tissue area was most obvious in complete remission group, followed by partial remission group and progression group. Statistical differences were found in the ADC value of tumor tissue area between complete remission group and partial remission group before and after treatment(P<0.05),while no statistical difference was found in the intra-group comparison(P>0.05). There were significant differences between any two groups at 1 month and 3 months after treatment(P<0.05), and the differences in the comparison among 3 groups has statistical significance(P<0.05). Conclusion The ADC value of magnetic resonance diffusion-weighted imaging provides a good reference value for the evaluation of chemotherapeutic efficacy of TACE in patients with liver cancer.
引文
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[10]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.GAO H Q,YU Y X,HU C H,et al.Application of diffusion-weighted imaging combined with Pumei magnetic resonance imaging in evaluating the efficacy of TACE after liver cancer[J].Journal of Interventional Radiology,2016,25(9):774-778.
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[13]章李,刘智俊.含脂肝细胞肝癌的影像表现和鉴别诊断[J].临床放射学杂志,2014,33(10):1529-1531.ZHANG L,LIU Z J.Image manifestation and differential diagnosis of liver cancer containing fatty liver[J].Journal of Clinical Radiology,2014,33(10):1529-1531.
[14]章李,刘智俊.15例含脂肝细胞肝癌的MRI影像特点[J].医学影像学杂志,2015,26(5):837-840.ZHANG L,LIU Z J.MRI features of 15 cases of hepatocellular carcinoma containing fatty liver[J].Journal of Medical Imaging,2015,26(5):837-840.
[15]王月波,陈加源.CT及MRI对原发性肝癌经导管肝动脉化疗栓塞术后疗效评估的对比[J].实用医学杂志,2017,33(18):3110-3114.WANG Y B,CHEN J Y.Comparison of CT and MRI in evaluating the therapeutic effect of transcatheter arterial chemoembolization for primary liver cancer[J].The Journal of Practical Medicine,2017,33(18):3110-3114.
[16]江旭,李慧,杨继金,等.常规TACE术中DSA诊断肝细胞癌切除术后3个月内复发[J].中国介入影像与治疗学,2018,15(7):387-391.JIANG X,LI H,YANG J J,et al.DSA diagnosis of recurrence within3 months after resection of hepatocellular carcinoma in conventional TACE[J].Chinese Journal of Interventional Imaging and Therapy,2018,15(7):387-391.
[17]刘光华,夏芳,欧阳强.肝动脉化疗栓塞对肝细胞癌切除术后预防复发的研究[J].介入放射学杂志,2015,24(2):125-129.LIU G H,XIA F,OUYANG Q.Study of hepatic arterial chemoembolization for prevention of recurrence after hepatocellular carcinoma resection[J].Journal of Interventional Radiology,2015,24(2):125-129.
[2]张薇薇,刘曦娇,李峥艳,等.Gd-EOB-DTPA增强MRI在肝脏局灶性病变中的应用进展[J].放射学实践,2016,31(1):44-48.ZHANG W W,LIU X J,LI Z Y,et al.Progress in the application of Gd-EOB-DTPA enhanced MRI in focal liver lesions[J].Radiology Practice,2016,31(1):44-48.
[3]武丽芳,颜竹芸,徐鹏举,等.ADC值变化率早期预测肝细胞癌(≤5.0 cm)TACE疗效的价值[J].放射学实践,2016,31(3):245-251.WU L F,YAN Z Y,XU P Y,et al.The value of ADC value change rate in predicting the efficacy of TACE in hepatocellular carcinoma(≤5.0cm)[J].Radiology Practice,2016,31(3):245-251.
[4]张坤,李绪斌,马菊香,等.肝细胞癌肿瘤ADC值与病理分级的相关性研究[J].临床放射学杂志,2016,35(5):728-731.ZHANG K,LI X B,MA J X,et al.Correlation between ADC values and pathological grade of hepatocellular carcinoma[J].Journal of Clinical Radiology,2016,35(5):728-731.
[5]赵伟,李文政,易小平,等.应用肝影像报告和数据系统MRI分级标准诊断原发性肝癌的诊断效能评价[J].中南大学学报(医学版),2016,41(4):380-387.ZHAO W,LI W Z,YI X P,et al.Diagnostic efficacy evaluation of primary liver cancer using liver imaging report and data system MRIgrading standard[J].Journal of Central South University(Medical Sciences),2016,41(4):380-387.
[6]杨欢,袁正,李文涛,等.磁共振表观弥散系数对肝癌TACE疗效的预测价值[J].中国癌症杂志,2016,26(3):257-262.YANG H,YUAN Z,LI W T,et al.Role of the apparent diffusion coefficient of MRI in evaluating therapeutic efficacy after transcatheter arterial chemoembolization in hepatic cancer patients[J].China Oncology,2016,26(3):257-262.
[7]沈锋,程张军.精准医学和大数据时代对肝癌临床研究的认识[J].中国实用外科杂志,2016,36(6):599-602.SHEN F,CHENG Z J.Understanding of clinical research on liver cancer in the era of precision medicine and big data[J].Chinese Journal of Practical Surgery,2016,36(6):599-602.
[8]KLOMPENHOUWER E G,DRESEN R C,VERSLYPE C,et al.Transarterial radioembolization following chemoembolization for unresectable hepatocellular carcinoma:response based on apparent diffusion coefficient change is an independent predictor for survival[J].Cardiovasc Intervent Radiol,2018,41(11):1716-1726.
[9]VOUCHE M,SALEM R,LEWANDOWSKI R J,et al.Can volumetric ADC measurement help predict response to Y90 radioembolization in HCC?[J].Abdom Imaging,2015,40(6):1471-1480.
[10]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.GAO H Q,YU Y X,HU C H,et al.Application of diffusion-weighted imaging combined with Pumei magnetic resonance imaging in evaluating the efficacy of TACE after liver cancer[J].Journal of Interventional Radiology,2016,25(9):774-778.
[11]MORIYA T,SAITO K,TAJIMA Y,et al.3D analysis of apparent diffusion coefficient histograms in hepatocellular carcinoma:correlation with histological grade[J].Cancer Imaging,2017,17(1):1.
[12]俞礽爱,刘佳,乐弈,等.外科手术联合TACE治疗晚期肝癌合并门静脉癌栓的疗效分析[J].中国普通外科杂志,2015,24(7):933-938.YU R A,LIU J,LE Y,et al.Therapeutic effect of surgery combined with TACE in the treatment of advanced hepatocellular carcinoma with portal vein tumor thrombus[J].Chinese Journal of General Surgery,2015,24(7):933-938.
[13]章李,刘智俊.含脂肝细胞肝癌的影像表现和鉴别诊断[J].临床放射学杂志,2014,33(10):1529-1531.ZHANG L,LIU Z J.Image manifestation and differential diagnosis of liver cancer containing fatty liver[J].Journal of Clinical Radiology,2014,33(10):1529-1531.
[14]章李,刘智俊.15例含脂肝细胞肝癌的MRI影像特点[J].医学影像学杂志,2015,26(5):837-840.ZHANG L,LIU Z J.MRI features of 15 cases of hepatocellular carcinoma containing fatty liver[J].Journal of Medical Imaging,2015,26(5):837-840.
[15]王月波,陈加源.CT及MRI对原发性肝癌经导管肝动脉化疗栓塞术后疗效评估的对比[J].实用医学杂志,2017,33(18):3110-3114.WANG Y B,CHEN J Y.Comparison of CT and MRI in evaluating the therapeutic effect of transcatheter arterial chemoembolization for primary liver cancer[J].The Journal of Practical Medicine,2017,33(18):3110-3114.
[16]江旭,李慧,杨继金,等.常规TACE术中DSA诊断肝细胞癌切除术后3个月内复发[J].中国介入影像与治疗学,2018,15(7):387-391.JIANG X,LI H,YANG J J,et al.DSA diagnosis of recurrence within3 months after resection of hepatocellular carcinoma in conventional TACE[J].Chinese Journal of Interventional Imaging and Therapy,2018,15(7):387-391.
[17]刘光华,夏芳,欧阳强.肝动脉化疗栓塞对肝细胞癌切除术后预防复发的研究[J].介入放射学杂志,2015,24(2):125-129.LIU G H,XIA F,OUYANG Q.Study of hepatic arterial chemoembolization for prevention of recurrence after hepatocellular carcinoma resection[J].Journal of Interventional Radiology,2015,24(2):125-129.