原发性肝细胞癌射频消融治疗前后的核磁共振成像影像分析

发布时间：2019-06-27 16:48

【摘要】：目的：探讨原发性肝细胞癌射频消融治疗前后核磁共振成像的变化特点及应用价值。 材料和方法：分析24例符合临床病理标准的原发性肝细胞癌患者的MR影像资料，共25个病灶首次行射频消融术； MRI检查时间为射频术前2天内，射频术后1个月复查；应用Siemens Verio3.0T超导型磁共振扫描仪，进行常规T1WI、T2WI、动态增强以及DWI扫描；分别测定射频消融术前以及术后活性区、病灶过渡区、正常肝脏的ADC值；使用成对样本t检验及重复测量方差分析进行数据分析。 结果：病灶的术前T1WI表现为低信号；T2WI表现为稍高或较高信号；DWI表现为高信号；ADC图像为低信号；动态增强扫描表现为动脉期强化，门静脉期及延时期信号下降；消融术后T1WI平扫信号有不同程度增高；T2WI、DWI信号有不同程度下降；ADC图像信号有不同程度增高；动态增强扫描治疗区内部均未见明显动脉期强化。配对t检验显示射频消融术后坏死灶的ADC值高于术前病灶实质，差异具有显著性（t=-4.049，P＜0.01）；术后治疗区过渡部分的ADC值高于术前，差异具有显著性（t=-2.217，，P＜0.05）。边缘残留及复发病灶与正常信号的边缘、治疗区以远肝脏组织、消融坏死灶的ADC值比较均有下降，差异具有显著性（P＜0.05）；重复测量方差分析结果显示：在不同个体间，治疗前病灶部位的ADC值最小，为（0.86705±0.14728）×10-3mm2/s，其次为过渡部位，为（1.07806±0.23537）×10-3mm2/s，而正常肝脏部位的ADC值最大，为（1.25944±0.17809）×10-3mm2/s，三部位两两比较差异均有统计学意义（P0.05）；治疗后，三部位的ADC值，依次分别为（1.18284±0.3517）×10-3mm2/s、（1.21421±0.25481）×10-3mm2/s、（1.20954±0.17337）×10-3mm2/s,ADC值虽略有差异，但差异无统计学意义（P0.05）。过渡部位和病灶部位治疗后的ADC值与治疗前相比差异均有统计学意义（P0.05），而正常肝脏组织治疗前后的差异则无统计学意义（P=0.237）。 结论：核磁共振检查不但是原发性肝癌临床诊断的标准之一；更可以作为射频消融治疗后疗效评价的手段。
[Abstract]:Objective: to investigate the characteristics and application value of nuclear magnetic resonance imaging (MRI) before and after radiofrequency ablation of primary hepatocellular carcinoma (HCC). Materials and methods: the MR data of 24 patients with primary hepatocellular carcinoma according to clinicopathological criteria were analyzed, 25 lesions were treated with radiofrequency ablation for the first time, MRI was examined within 2 days before radiofrequency surgery and 1 month after radiofrequency surgery, and conventional T1WI, T2WI, dynamic enhancement and DWI scan were performed with Siemens Verio3.0T superconducting magnetic resonance scanner. The ADC values of active area, lesion transition area and normal liver were measured before and after radiofrequency ablation, and the data were analyzed by pairwise sample t test and repeated measurement variance analysis. Results: the lesions showed low signal intensity before operation; T2WI showed slightly higher or higher signal intensity; DWI showed high signal intensity; ADC image showed low signal intensity; dynamic contrast-enhanced scan showed arterial phase enhancement and portal vein phase and delayed signal decrease; T1WI plain scan signal increased in varying degrees after ablation; T2WI signal decreased in varying degrees; ADC image signal increased in varying degrees. There was no obvious arterial phase enhancement in the treatment area of dynamic contrast-enhanced scanning. Pairing t test showed that the ADC value of the lesion after radiofrequency ablation was significantly higher than that before operation (t 鈮

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