多模态MRI扫描评价原发性肝癌TACE术后疗效的临床应用研究

发布时间：2018-05-29 21:28

本文选题：TACE术后 + 原发性肝癌　；参考：《吉林大学》2014年硕士论文

【摘要】：目的：探索原发性肝癌经导管动脉化疗栓塞（transarterialchemoembolization，TACE）术后1个月的表观弥散系数值(apparentdiffusion coefficient，， ADC)及门静脉期增强信号强度（venousenhancement，VE）的变化程度与TACE术后6个月按照RECIST标准评估肿瘤治疗疗效的相关性。方法：通过回顾性分析2009年3月至2013年7月份的48名分别在TACE术前、术后1个月、术后6个月行中磁共振扫描的原发性肝癌患者的71个目标病灶（病灶面积范围：1~25mm2）。按照实体瘤疗效评价标准（Response Evaluation Criteria in Solid Tumors，RECIST）或修订后的RECIST标准分类对TACE术后6个月的原发性肝癌病灶治疗疗效进行评估、分类，同时分析TACE术前及术后1个月目标病灶面积最大层面上ADC值及VE值的变化程度，并分析治疗疗效同ADC值及VE值变化的相关性，并建立ADC值及VE值的变化程度的受试者工作特性曲线（receiver operating characteristic，ROC）评价其分类病灶疗效的准确性。结果：按照RECIST标准，TACE术后6个月的71个目标病灶评估为30个部分缓解病灶（partial response，PR），35个稳定病灶（stable disease，SD），6个进展病灶（progressive disease，PD）。与TACE术前MR比较，71个目标病灶TACE术后1个月ADC值均增加和VE值均下降并且具有统计学意义。ADC增加和VE下降的程度在PR、SD、PD存在组间差异。以ADC值增加的百分数为参数绘制PR组和（SD组+PD组）的ROC曲线图，其ROC曲线下面积（underthe ROC curve，AUC）为0.78，临界值是51.3%，此时的灵敏度为70%，特异度为73.2%；以ADC值增加的百分数为参数绘制（PR组+SD组）和PD组的ROC曲线，其AUC为0.89，临界值是29.3%，此时的灵敏度为83%，特异度为100%。以VE值下降的百分数为参数绘制PR组和（SD组+PD组）的ROC曲线图，其AUC为0.73，临界值为51.9，此时的灵敏度为51.9%，特异度为63.4%；以VE值下降的百分数为参数绘制（PR组+SD组）和PD组的ROC曲线，其AUC为0.90，临界值是26.8%，此时的灵敏度为86.2%，特异度为100%。结论：TACE术后1个月的病灶ADC值的增加程度和VE值的下降程度可以预测的TACE远期疗效。多模态MR数据分析可以作为HCC患者TACE治疗后远期疗效评估的生物标志。
[Abstract]:Objective : To explore the correlation between apparent diffusion coefficient ( ADC ) and portal venous phase enhanced signal intensity ( VE ) in patients with primary hepatocellular carcinoma ( HCC ) after transcatheter arterial chemotherapy ( TACE ) for 1 month after TACE .

Methods : Seventy - eight primary liver cancer patients ( 1 - 25 mm2 ) were analyzed retrospectively for the primary liver cancer patients who underwent magnetic resonance imaging before TACE , 1 month after TACE and 6 months after TACE . To evaluate the efficacy of response Evaluation Criteria in Solid Tumors ( RECIST ) or revised RECIST criteria for the treatment of primary liver cancer lesions for 6 months after TACE , and to analyze the correlation between ADC values and VE values at the largest level of target lesion area before and after TACE , and to analyze the correlation between the therapeutic efficacy and ADC value and VE value , and to establish the receiver operating characteristic ( ROC ) of ADC values and VE values to evaluate the accuracy of its classified lesions .

Results : According to RECIST criteria , 71 target lesions were assessed as 30 partial response ( PR ) , 35 stable disease ( SD ) and 6 progressive disease ( PD ) in 30 partial response lesions in 6 months after TACE . Compared with the pre - TACE MR , the ADC value increased and the value of VE decreased and the value of VE decreased after TACE in 71 target lesions . The ROC curve of PR group and ( SD group + PD group ) was plotted with the increase of ADC value . The ROC curve under ROC curve was 0.78 , the critical value was 51.3 % , the sensitivity was 70 % and the specificity was 73.2 % .
The ROC curves of PR group + SD group and PD group were plotted as the percentage of ADC value . The AUC was 0.89 , the critical value was 29 . 3 % , the sensitivity was 83 % and the specificity was 100 % . The ROC curve of PR group and ( SD group + PD group ) was plotted as the percentage of VE value . The AUC was 0.73 , the critical value was 51.9 , the sensitivity was 51.9 % and the specificity was 63.4 % .
The percentage of VE value decreased as parameter ( PR group + SD group ) and ROC curve of PD group . The AUC was 0.90 and the critical value was 26 . 8 % . At this time , the sensitivity was 86.2 % and the specificity was 100 % .

Conclusion : The increase of ADC value and the decrease of VE value can be predicted by TACE in 1 month after TACE . Multi - modal MR data analysis can be used as biomarker of long - term efficacy assessment after TACE in HCC patients .
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R735.7;R445.2

【参考文献】