弥散加权成像联合普美显磁共振成像在肝癌TACE术后疗效评估中的应用

发布时间：2018-03-28 03:26

本文选题：弥散加权成像　切入点：肝细胞特异性对比剂　出处：《介入放射学杂志》2016年09期

【摘要】：目的探讨弥散加权成像(DWI)联合普美显(Gd-EOB-DTPA)MR成像在肝癌TACE后疗效评估中的应用价值。方法 20例确诊肝癌患者于TACE术前、术后行上腹部DWI及Gd-EOB-DTPA动态增强扫描,定性分析TACE术前、术后肝癌活性成分,坏死和复发转移情况。测量TACE术前、术后病灶的表观弥散系数(ADC)值和信号值(signal intensity,SI),并计算术前、术后病灶的动脉期对比增强比(CER)和动脉期的信号比(SIR),对定量参数ADC、CER和SIR值进行配对样本t检验。结果本组20例患者共检出肝癌病灶45个。TACE术后瘤灶内残存及复发部分在DWI图像上呈高信号,ADC图上信号低于正常肝组织,动脉期可见明显强化,门脉期及平衡期强化减退,肝胆特异期呈明显低信号;瘤灶内坏死部分DWI序列呈低信号,ADC图上为高信号,增强扫描后无强化,肝胆特异期亦呈明显低信号。肝癌病灶术前、术后ADC值分别为(1.52±0.16)×10~(-3)mm~2/s和(1.70±0.28)×10~(-3) mm~2/s,术后肝癌病灶的ADC值普遍升高,两者的差异有统计学意义。肝癌TACE术后的CER_(动脉期)和SIR_(动脉期)值减小,与术前相比,两者的差异有统计学意义。有效组肝癌病灶的术后ADC值大于无效组,而其CER_(动脉期)和SIR_(动脉期)值均小于无效组,两者术后的ADC、CER_(动脉期)和SIR_(动脉期)值的差异均有统计学意义。结论联合应用DWI和GdEOB-DTPA增强MR成像能有效评估肝癌TACE术后病灶存活及坏死情况,检出早期复发、新发灶及转移灶,对制定下一步治疗方案具有重要意义。
[Abstract]:Objective to evaluate the value of DWI and Gd-EOB-DTPA-Mr imaging in evaluating the curative effect of hepatocellular carcinoma after TACE. Methods Twenty patients with liver cancer diagnosed before and after TACE underwent DWI and Gd-EOB-DTPA dynamic enhancement scanning before and after operation, and the preoperative TACE was analyzed qualitatively. After operation, the active components, necrosis, recurrence and metastasis of liver cancer were measured before and after TACE. The apparent diffusion coefficient and signal signal intensity were measured before and after TACE. The arterial phase contrast enhancement ratio (CER) and the signal ratio of arterial phase (SIRR) and signal ratio (SIRR) of the lesion after operation were measured by paired t-test of quantitative parameters (ADCC CER and SIR). Results A total of 45 HCC foci were detected in this group of 20 patients with residual and recurrent lesions after TACE. Some of the signals on DWI images were lower than those on normal liver tissues. In arterial phase, the enhancement of portal vein phase and balance phase was decreased, and the signal intensity of hepatobiliary specific phase was obviously low, and the DWI sequence of necrotic part of the tumor showed high signal intensity, but no enhancement after contrast-enhanced scan. The ADC values of liver cancer focus before and after operation were 1.52 卤0.16 脳 10~(-3)mm~2/s and 1.70 卤0.28 脳 10 ~ (-3) mm ~ (-3) mm / s, respectively. The ADC value of liver cancer focus increased generally after operation. There was a significant difference between the two groups. The ADC value of the liver cancer after TACE was higher than that of the ineffective group, and the ADC values of the two groups were significantly lower than those of the patients with TACE. The difference between the two groups was statistically significant, and there was a significant difference between the two groups, and the ADC value of the effective group was higher than that of the non-effective group. The values of CERT (arterial phase) and Sir (arterial phase) were lower than those of invalid group. There were statistically significant differences between the two groups in ADCC CER (arterial phase) and Sir _ s (arterial phase). Conclusion the combined use of DWI and GdEOB-DTPA enhanced Mr imaging can effectively evaluate the survival and necrosis of liver cancer after TACE, and detect early recurrence, new focus and metastasis. It is of great significance to make the next treatment plan.
【作者单位】：宁波大学医学院附属医院放射科;苏州大学附属第一医院放射科;
【分类号】：R735.7;R730.55;R445.2

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