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DWI及其MRI增强扫 描在肝癌TACE介入 治疗术后早期疗效 中的评估价值

作者:唐启耀1 尹 君1 靳雪广1 凌盈盈2 温一阳3

所属单位:1.河南省信阳市中心医院介入放射 科 (河南 信阳 464000) 2.河南省信阳市中心医院影像科 (河南 信阳 464000) 3.河南省人民医院肿瘤内科 (河南 郑州 450003)

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摘要

目的 探讨弥散加权成像(DWI)及 其MRI增强扫描在TACE介入术后早期疗效 中的评估价值。方法 以2015年6月-2016 年8月我院收治的210例肝癌TACE介入治疗 患者为对象,纳入患者术前和术后分别行 DWI扫描检查及MRI增强扫描检查,参照实 体瘤疗效评估标准(RECIST)将治疗结果分 为有效组及无效组,观察患者治疗前后影 像学表现,并比较两组治疗前、后影像学 定量变化。结果 210例患者,共检出260 个肝癌病灶,肿瘤平均直径约为7.56cm, 肝癌患者TACE治疗前后影像学表现具有典 型性;术后肝癌患者病灶ADC值较术前明 显升高,肝癌患者术后CER动脉期、SIR动 脉期值较术前明显减小,差异有统计学意 义(P<0.05);术后与无效组相比较,有 效组肝癌病灶的ADC值明显大,但CER动脉 期、SIR动脉期值明显小,差异有统计学 意义(P<0.05)。结论 DWI及其MRI增强扫 描可有效评估肝癌TACE介入术后病灶存活 及坏死情况,对评估早期临床疗效及指导 临床下一步治疗方案有重要参考价值。

Objective To investigate the value of diffusion weighted imaging (DWI) and its MRI enhanced scan in evaluating the early curative effect of transcatheter arterial chemoembolization (TACE) interventional therapy on liver cancer. Methods A total of 210 patients with liver cancer treated by TACE interventional therapy in the hospital from June 2015 to August 2016 were enrolled in the study, and they were examined with DWI scan and MRI enhanced scan before operation and after operation respectively. Referring to the Response Evaluation Criteria In Solid Tumors (RECIST), the treatment outcomes were divided into effective group and ineffective group. Imaging findings of patients were observed before and after treatment, and imaging quantitative changes were compared between the two groups before and after treatment. Results In the 210 patients, a total of 260 lesions were detected, and the average diameter of tumors was about 7.56cm. The imaging features of patients with liver cancer were typical before and after TACE. The ADC values of lesions in patients with liver cancer after operation were significantly higher than those before operation. The values of CER arterial phase and SIR arterial phase in patients with liver cancer after operation were significantly lower than those before operation (P<0.05). After operation, the ADC value of effective group was significantly larger than that of the ineffective group, but the CER arterial phase and SIR arterial phase were significantly smaller than those in the ineffective group (P<0.05). Conclusion DWI and its MRI enhanced scan can effectively assess the survival and necrosis of lesions in patients with liver cancer after TACE interventional therapy, which is of important reference value in evaluating the early curative effect and guiding the further treatment.

【关键词】肝癌;经导管动脉化疗栓塞介 入治疗;DWI;MRI;早期疗效

【中图分类号】R735.7

【文献标识码】A

【DOI】10.3969/j.issn.1672- 5131.2017.12.020

前言

肝癌为临床常见多发恶性肿瘤之一,有病情隐匿、进展快、易恶 化等特点,并且致残率和病死率高,手术切除仍是早期肝癌患者首选 治疗方案[1],而国内肝癌多由乙肝、肝硬化等发展而来,且超过一半 的肝癌患者因疾病进展或肝功能下降等原因已失去最佳手术切除机 会[2]。现阶段TACE已成为无法进行手术切除的中晚期肝癌患者的重要 治疗手段,但TACE为临床姑息性治疗手段,肝癌患者常需经多次和重 复治疗,且在治疗过程中需多次评估其治疗疗效,才能取得较佳的 TACE介入治疗效果[3]。早期准确评估肝癌患者TACE的疗效对临床下一 步治疗方案的制定有重要参考价值,随医学水平和影像学技术不断发 展,DWI及其MRI增强扫描在评估肝癌介入治疗术后的早期疗效中应用 日益普及[4],但有关何种评估手段更具应用优势尚存在一定争议,本 研究旨在探讨DWI及其MRI增强扫描在肝癌TACE介入治疗术后早期疗效 中的评估价值。