功能磁共振在肝癌TACE术后疗效定量评价中的应用研究
发布时间：2018-11-14 17:23
【摘要】：目的： 1.评估不同感兴趣区设置方法对肝癌患者肝动脉化疗栓塞（TACE）术治疗前后ADC值测量及观察者之间变异的影响。 2.探讨磁共振扩散加权成像在肝癌TACE术后疗效监测中的应用价值。 3.研究3.0T MR动态增强扫描定量参数在TACE术后疗效评估中的应用价值。 方法: 1.36例经病理、临床及影像学证实中晚期肝癌患者于TACE术前、术后1个月行扩散加权成像检查(b=0，1000)。两位有经验的放射科医生分别采用整体容积法、最大层面法、多个小样本法三种不同ROI设置方法对肝癌病灶行ADC值测量。对不同ROI设置方法测量的平均ADC±SD值及观察者之间变异的差异用组内相关系数（ICC）进行对比分析。 2.32例经病理、临床及影像学证实的中晚期肝癌患者于TACE术前、术后1个月行扩散加权成像及动态增强扫描检查，通过测量TACE术前、术后肿瘤的大小、正常肝脏组织和肿瘤的ADC值及两者差值，观察TACE术后肿瘤表观弥散系数值的变化趋势及肝癌坏死情况，评价TACE术后一月的动态增强扫描强化早期病灶液化坏死范围，并以肿瘤坏死≥50%为标准将病灶分为有效组及无效组，判断TACE术治疗后肿瘤复发或残存情况，并预测患者远期生存情况。 3.用3.0T磁共振对经病理、临床及影像学证实的24例肝癌患者分别于TACE术前一周内，术后1个月及3个月分别进行动态增强扫描，影像学测量肿瘤横轴位最长径，以及肝癌TACE术前、后动态增强扫描定量参数：Ktrans，Kep，ve，进行单因素方差分析，P0.05为结果有统计学意义。 结果: 1.三种ROI设置方法在不同观察者间均存在较好的一致性(P0.05,ICC=0.99)。整体容积法ROI的ICC在TACE术前非常好（0.91），在TACE术后良好（0.79），单层最大层面法在TACE术前、术后的ICC分别为0.77和0.63，多个小样本法的ICC分别为0.76和0.37。多个小样本法TACE术前ADC值低于整体容积法或最大层面法。TACE术后的ADC值在整体容积、最大层面或多个小样本ROI间差异无统计学意义。整体容积和最大层面ROI的SD显著大于多个小样本ROI。 2.对比肝癌TACE术前、术后肿瘤的ADC值变化，术后一个月ADC值普遍升高，无效组术前ADC值低于有效组，有效组术后ADC值高于无效组，无效组术前、术后ADC值变化不大，有效组治疗前、后ADC值变化显著。术前、术后ADC（%）值越大，，治疗效果越好，两者之间存在统计学差异；TACE术前、术后肿瘤大小及其周围正常肝脏组织ADC值变化均无统计学差异。 3.（1）以RECIST为标准，将治疗结果分为有效组18个，无效组6个。（2）以RECIST标准为参考时，治疗前无效组与有效组间Ktrans值差异具有统计学意义。（3）在肝癌TACE术后，RECIST评估标准中的有效组与无效组间Ktrans值、Kep值在治疗前与第1个月后复查、治疗前与第3个月后复查变化差异均有统计学意义。结论: 1. ROI设置大小和位置对肿瘤的ADC值测量和观察者间变异有一定的影响。肝癌TACE术后观察者间变异性较大。整体容积法获得的肿瘤ADC值最具可重复性。 2. DWI作为无创、无辐射性检查方法，可以更好的用于预测评估肝癌TACE术后疗效。 3.以RECIST标准评估疗效时，治疗前Ktrans值具有预测作用，磁共振动态增强扫描可用于肝癌TACE术后疗效评估，其参数Ktrans、Kep可定量评估疗效。
[Abstract]:Purpose: 1. To evaluate the change between the ADC value and the observer before and after the treatment of hepatic artery chemoembolization (TACE) in patients with liver cancer with different region of interest setting method The effect of magnetic resonance diffusion weighted imaging in the treatment of hepatocellular carcinoma after TACE Application value of 3. 0T MR dynamic enhanced scan quantitative parameters in TACE In the assessment The application value of the method was 1. 36 cases of advanced liver cancer were confirmed by pathology, clinical and imaging, and the diffusion weighting was performed for 1 month after the operation of TACE. Imaging examination (b = 0,1000). Two experienced radiologists use the overall volume method, the maximum level method, the multiple small sample methods, and the three different ROI settings Methods The ADC value of the liver cancer was measured. The mean ADC value and the difference of the variation between the observer and the observer were measured in different ROI setting methods. The relationship number (ICC) was compared and analyzed. 2. 32 patients with advanced liver cancer confirmed by pathology, clinical and imaging were examined by diffusion-weighted imaging and dynamic enhanced scan before and after TACE, and the size of the tumor after TACE was measured before and after TACE. The value of the ADC and the difference of the two values of the liver tissue and the tumor were observed. The trend of the numerical value of the apparent diffusion coefficient of the tumor after TACE and the condition of the necrosis of the liver cancer were observed. 0% of the lesions were divided into an effective group and an invalid group, and the tumor recurrence after the treatment of TACE was judged. or the survival of the patients, and the long-term survival of the patients was predicted. 3. 24 cases of liver cancer, which were confirmed by pathology, clinical and imaging, were respectively and dynamically enhanced in the first one week and the third month after the operation of the TACE in the 3. 0T magnetic resonance imaging. The longest diameter of the transverse axis of the tumor and the quantitative parameters of the dynamic enhanced scan before and after the operation of the TACE of the liver cancer: Ktrans, Kep, ve, and the single cause variance of prime The results are as follows: 1. Three kinds of ROI setting methods are in different observers The ICC was very good (P0.05, ICC = 0.99). The ICC of the whole volume method was very good (0.91) before TACE, and good (0.79) after TACE. The maximum level of the single layer was 0.77 and 0 before the TACE.. 63. The ICC of multiple small sample methods is 0.76 and 0.37, respectively. The pre-operative ADC value of the sample method TACE is lower than the overall volume method or the maximum level method. The ADC values after the TACE are rounded There is no statistical significance between the volume of the volume, the maximum level, or the multiple small sample ROI. The volume of the volume and the SD of the maximum level of the ROI were significantly greater than that of the multiple small samples of ROI. 2. The ADC value of the post-operative tumor changes before and after the TACE operation in the liver cancer. The ADC value was generally increased one month after the operation. The ADC value before the operation was lower than that of the effective group. The ADC value in the effective group was higher than that of the invalid group. Before operation, the greater the value of ADC (%), the better the value of the post-operative ADC, the better the value of the ADC (%) after the operation, the better the treatment effect, the difference between the two, and before the TACE, Post-op There was no statistical difference in the size of the tumor and the changes in the ADC value of the normal liver tissue around it. (1) According to RECIST as the standard, the treatment results were divided into 18 effective groups and 6 ineffective groups. (2) RECIST criteria For reference, the difference of the Ktrans values between the ineffective group and the effective group was of statistical significance. (3) The Ktrans value between the effective group and the ineffective group in the RECIST evaluation standard after the TACE of the liver cancer was the same as that of the effective group, and the Kep value was in the treatment group. Front and After 1 month, there was a significant difference in the post-treatment and 3-month post-treatment review. Conclusion: 1. ROI setting size and position versus tumor The ADC value measurement and the inter-observer variability have a certain effect. The inter-observer variability was large after TACE in liver cancer. The value of the tumor ADC obtained by the whole volume method was the most reproducible. 2. DWI was used as a non-invasive and non-radiative method, which could be used to predict the efficacy of TACE in the evaluation of liver cancer.
【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.2;R735.7
本文编号：2331816
[Abstract]:Purpose: 1. To evaluate the change between the ADC value and the observer before and after the treatment of hepatic artery chemoembolization (TACE) in patients with liver cancer with different region of interest setting method The effect of magnetic resonance diffusion weighted imaging in the treatment of hepatocellular carcinoma after TACE Application value of 3. 0T MR dynamic enhanced scan quantitative parameters in TACE In the assessment The application value of the method was 1. 36 cases of advanced liver cancer were confirmed by pathology, clinical and imaging, and the diffusion weighting was performed for 1 month after the operation of TACE. Imaging examination (b = 0,1000). Two experienced radiologists use the overall volume method, the maximum level method, the multiple small sample methods, and the three different ROI settings Methods The ADC value of the liver cancer was measured. The mean ADC value and the difference of the variation between the observer and the observer were measured in different ROI setting methods. The relationship number (ICC) was compared and analyzed. 2. 32 patients with advanced liver cancer confirmed by pathology, clinical and imaging were examined by diffusion-weighted imaging and dynamic enhanced scan before and after TACE, and the size of the tumor after TACE was measured before and after TACE. The value of the ADC and the difference of the two values of the liver tissue and the tumor were observed. The trend of the numerical value of the apparent diffusion coefficient of the tumor after TACE and the condition of the necrosis of the liver cancer were observed. 0% of the lesions were divided into an effective group and an invalid group, and the tumor recurrence after the treatment of TACE was judged. or the survival of the patients, and the long-term survival of the patients was predicted. 3. 24 cases of liver cancer, which were confirmed by pathology, clinical and imaging, were respectively and dynamically enhanced in the first one week and the third month after the operation of the TACE in the 3. 0T magnetic resonance imaging. The longest diameter of the transverse axis of the tumor and the quantitative parameters of the dynamic enhanced scan before and after the operation of the TACE of the liver cancer: Ktrans, Kep, ve, and the single cause variance of prime The results are as follows: 1. Three kinds of ROI setting methods are in different observers The ICC was very good (P0.05, ICC = 0.99). The ICC of the whole volume method was very good (0.91) before TACE, and good (0.79) after TACE. The maximum level of the single layer was 0.77 and 0 before the TACE.. 63. The ICC of multiple small sample methods is 0.76 and 0.37, respectively. The pre-operative ADC value of the sample method TACE is lower than the overall volume method or the maximum level method. The ADC values after the TACE are rounded There is no statistical significance between the volume of the volume, the maximum level, or the multiple small sample ROI. The volume of the volume and the SD of the maximum level of the ROI were significantly greater than that of the multiple small samples of ROI. 2. The ADC value of the post-operative tumor changes before and after the TACE operation in the liver cancer. The ADC value was generally increased one month after the operation. The ADC value before the operation was lower than that of the effective group. The ADC value in the effective group was higher than that of the invalid group. Before operation, the greater the value of ADC (%), the better the value of the post-operative ADC, the better the value of the ADC (%) after the operation, the better the treatment effect, the difference between the two, and before the TACE, Post-op There was no statistical difference in the size of the tumor and the changes in the ADC value of the normal liver tissue around it. (1) According to RECIST as the standard, the treatment results were divided into 18 effective groups and 6 ineffective groups. (2) RECIST criteria For reference, the difference of the Ktrans values between the ineffective group and the effective group was of statistical significance. (3) The Ktrans value between the effective group and the ineffective group in the RECIST evaluation standard after the TACE of the liver cancer was the same as that of the effective group, and the Kep value was in the treatment group. Front and After 1 month, there was a significant difference in the post-treatment and 3-month post-treatment review. Conclusion: 1. ROI setting size and position versus tumor The ADC value measurement and the inter-observer variability have a certain effect. The inter-observer variability was large after TACE in liver cancer. The value of the tumor ADC obtained by the whole volume method was the most reproducible. 2. DWI was used as a non-invasive and non-radiative method, which could be used to predict the efficacy of TACE in the evaluation of liver cancer.
【学位授予单位】：第四军医大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R445.2;R735.7
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