磁共振弥散加权成像在转移性肝癌RFA术后残留病灶的诊断价值

发布时间：2018-07-06 19:56

本文选题：转移性肝癌 + 射频消融术　；参考：《浙江大学》2014年硕士论文

【摘要】：背景和目的：肝脏是恶性肿瘤的常见转移部位,转移性肝癌的治疗效果直接影响患者的生存质量及生存期,其治疗仍是肿瘤治疗中的难题。转移性肝癌的预后取决于原发肿瘤的部位、肝脏受累范围及患者的全身情况等,1年生存率不到50%。所以,选择合适的治疗方案,尽量延长患者的有效生存期,是目前医学的挑战。随着医学的发展,出现了除了手术治疗以外的有效非手术治疗手段,包括射频消融术、肝动脉栓塞化疗、免疫治疗等,效果已被肯定,同时也存在难题,就是术后治疗灭活程度的评估,灭活不彻底的病灶需要及时进一步处理。因此,各种非手术治疗手段对于影像学技术的依赖性较高。近年来,部分学者已对各种影像学检查方式对于肝癌RFA术后效果的评价进行了探讨,包括超声造影(CEUS)、计算机断层扫描(CT)、磁共振扫描(MRI)等。其中,MRI检查具有成本高、速度较慢的特点,而CT辐射较为严重,CEUS对于操作者依赖度高。所以,需要在肝癌RFA术后综合各种检查手段,及时发现与处理残留与复发病灶。科技发展日新月异,MRI技术不断发展,如磁共振弥散成像(DWI)在腹部疾病诊断的应用,使得解决以上难题的道路上积累了更多经验。DWI是一种对水分子扩散运动敏感的成像技术,在常规自旋回波的T2扫描序列中加入对称的扩散敏感梯度脉冲(b值),使在施加梯度场方向上的水分子运动活跃,相位离散加剧,信号减低,b值越大,水分子的离相越重,信号降低越明显。通过b值可以计算出各种组织的表观弥散系数(ADC)。如果组织有病变,则其信号降低的程度有差别,从而通过ADC值发现病变。DWI目前在脑部的应用较为成熟,特别是对急性脑梗的诊断,但在腹部和其他脏器的应用尚处于探索阶段。近几年肝脏DWI的研究较多,包括肝癌TACE与RFA术后效果的评估。但是尚未有对于转移性肝癌RFA术后残留的研究。本研究旨在通过转移性肝癌RFA术后病灶不同区域ADC值的变化,探讨早期发现残留结节的可能性。方法：在我院行RFA治疗的转移性肝癌患者,在RFA术前(1个月)及术后7天、1个月及3个月分别进行磁共振扫描检查及超声造影检查。扫描后通过扫描仪自带软件产生ADC图,由2名经验丰富的磁共振诊断医师进行ADC值的测量(包括正常肝组织、中心完全消融区域及可疑残留区域),测量3次取平均值。由2名有经验的超声医师对各个结节的超声造影信息进行分析及诊断,判断有无残留及复发,意见不一致则讨论后达成诊断。计量资料用mean±SD表示,对不同区域肝脏RFA术前及术后图像信号ADC值之间进行多个随机样本参数采用单因素方差分析(one-way ANOVA)的Tukey分析,对RFA术后中心消融区及残留区之间的比较采用Wilcoxon非参数检验,以P0.05作为有显著性差异。结果： RFA术前及术后,正常肝组织的ADC值的变化无统计学意义(P0.05)。RFA术后中心完全消融区域的ADC值变化,术后均比术前升高,有显著性差异(P0.05)。周边可疑复发区域的ADC值,术前与术后的差异无统计学意义(P0.05)。RFA术后随访中,中心消融区较残留区ADC值均有显著升高(P0.05)。残留结节均由磁共振增强扫描图像及超声造影检查确诊。结论：本研究对于转移性肝癌RFA术后的病灶DWI图像信号进行了分析。通过ADC值的变化,RFA术后7天及后期随访中残留结节的ADC较术前均未发生显著变化,故可依此在早期发现残留结节,为进一步治疗提供了可靠诊断依据,对于提高完全消融率及延长患者的生存期具有一定意义。
[Abstract]:Background and Purpose :

The prognosis of metastatic liver cancer depends on the location of the primary tumor , the range of liver involvement and the systemic condition of the patient , and the 1 - year survival rate is less than 50 % . Therefore , it is the current medical challenge to select the appropriate treatment plan and extend the effective survival time of the patient as far as possible .

With the development of medical science , there have been effective non - surgical treatments besides surgical treatment , including radiofrequency ablation , hepatic artery embolization chemotherapy , immunotherapy , etc .

DWI is a sensitive imaging technique for the diffusion of water molecules .

In recent years , the study of liver DWI is much more , including the evaluation of TACE and postoperative effects of TACE . However , there has not been a study of postoperative residual liver cancer . The aim of this study is to explore the possibility of early detection of residual nodules by the change of ADC values in different regions of the lesions after the resection of hepatic carcinoma .

Method :

A single - factor ANOVA ( ANOVA ) was used to analyze the ADC values between different regions of the liver and the residual area was analyzed by means of single - way ANOVA .

Results :

There was no significant difference in ADC values of normal liver tissues before and after operation ( P0.05 ) . The ADC values of the central ablation region were significantly higher than those before operation ( P0.05 ) .

Conclusion :

The results showed that the residual nodules were found in the early stage and the later follow - up , so the residual nodules could be found in the early stage , thus providing a reliable diagnostic basis for further treatment , which has some significance for improving the complete ablation rate and prolonging the survival time of the patients .
【学位授予单位】：浙江大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R735.7;R445.2

【参考文献】