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HCC介入治疗疗效预期及评估的MRI多模态研究*

作者:喻朋辉1 赵香田2

所属单位:1.郑州人民医院影像科(河南 郑州 450003) 2.郑州大学第一附属医院磁共振室(河南 郑州 450003)

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摘要

目的回顾性分析原发性肝癌介 入治疗患者术后表观弥散系数和门静脉期 增强信号强度的变化,探究多模态MRI对 于原发性肝癌介入治疗疗效的评估作用。 方法 选择于2014年3月到2015年3月来我 院就诊的原发性肝癌患者共50例,分别在 治疗前,治疗后1个月,治疗后6个月对患 者行核磁共振扫描,根据对比治疗前后患 者表观弥散系数和门静脉期增强信号强度 变化对患者治疗效果进行评价。结果 HCC 介入治疗前病灶区域表观弥散系数值为 (1.23±0.37)×10-3mm2 ,而经过治疗后其 平均值为(1.93±0.53)×10-3mm2 ,两组数 据存在显著差异(P<0.05);治疗前病灶门 静脉期增强信号强度均值为(59±19)%, 而治疗后为(47±21)%,与治疗前相比出 现显著下降(P<0.05)。治疗后6个月进行 随访,对病灶疗效进行分类,共81个病 灶,其中部分缓解为34个,稳定病灶为36 个,进展病灶为11个;利用非参数ROC曲 线分析发现各疗效组的表观弥散系数值和 门静脉期增强信号强度值改变情况存在显 著差异(P<0.05)。结论 MRI多模态研究可 以作为HCC介入治疗后疗效预期及评估的 生物学指标,通过表观弥散系数和门静脉 期增强信号强度的改变程度可以预测疗 效。

Objective To analyze the changes of the apparent diffusion coefficient and the signal intensity of portal vein in patients with primary hepatocellular carcinoma (HCC) retrospectively, and to explore the effect of multimode MRI on the efficacy of interventional therapy for primary liver cancer. Methods A total of 50 patients with primary hepatocellular carcinoma who were treated in our hospital from March 2014 to March 2015 were enrolled in this study. the patients underwent nuclear magnetic resonance scan before, 1 month after treatment and 6 months after treatment,. Comparison of the apparent diffusion coefficient and the enhancement of signal intensity in the portal vein before and after treatment were evaluated. Results The apparent diffusion coefficient was (1.23±0.37)×10-3mm2 before the treatment of HCC, and the mean value was (1.93±0.53)×10-3mm2 after treatment. There was significant difference between the two groups (P<0.05) The mean signal intensity of the portal vein was (59±19)% and (47±21)% after treatment, which was significantly lower than that before treatment (P <0.05). 6 months after treatment, the efficacy of the lesion was classified, a total of 81 lesions, including some of the relief of 34, stable lesions of 36, the progress of 11 lesions, the use of nonparametric ROC curve analysis found that the efficacy of the table (P<0.05). There is a significant difference between the two groups (P<0.05). Conclusion MRI multimodal study can be used as an indicator of the efficacy and prognosis of HCC after interventional therapy. The effect of the therapy can be predicted by the degree of change of the signal intensity and the enhancement of signal intensity through the apparent diffusion coefficient and portal vein.

【关键词】原发性肝癌;表观弥散系数; 经导管动脉化疗栓塞术;临床疗效;疗效预测

【中图分类号】R322.4+7

【文献标识码】A

【DOI】10.3969/j.issn.1672-5131.2018.09.045

前言

原发性肝癌是现代人常见的恶性肿瘤之一,也是最常见的癌症相 关死亡原因之一,仅次于肺癌和胃癌。由于该病起病隐匿,因此确诊 时患者大多处于中或晚期,无法得到及时的治疗,给患者带来严重的 健康威胁[1-5]。如何做到原发性肝癌的早期评估成为现今研究的热点问 题。多模态MR是一种新型的影像学检查手段,可进行多方位,多参数 以及多序列的成像,软组织分辨率高,电离辐射小,可行无对比剂血 管成像,信息丰富,在原发性肝癌的诊断上具有较大的优势。因此在 本次的研究中,我们在医学伦理委员会的批准同意下,通过观察手术 治疗前后原发性肝癌患者病灶变化情况,回顾性探究多模态MR对于HCC 介入治疗的疗效。