磁共振扩散加权成像评价原发性肝癌经导管动脉化疗栓塞术疗效的随访研究

目的 探讨磁共振扩散加权成像(DWI)在原发性肝癌经导管动脉化疗栓塞术(TACE)疗效评价中的作用.方法 对25例原发性肝癌并行TACE治疗的患者在首次TACE术前及每次术后4～6周常规行MRI T1、WI T2、DWI和动态增强扫描,并对肿瘤残余、坏死、肿瘤复发组织的表观扩散系数(ADC)值进行对比研究.结果 在b值为1000 s/mm2时,肝组织、术前肿瘤组织、术后残余肿瘤组织、术后凝固性坏死组织、术后复发肿瘤组织的ADC值(mm·s-1·10-3)分别为:1.25±O.07、1.02±0.19、1.06±0.14、1.68±0.32、1.28±0.07.术后凝固性坏死组织ADC最高,其与其余各组织间差异均有统计学意义(F值为23.25,P<0.05);术前肿瘤组织最低,术后复发肿瘤组织高于前者,且差异有统计学意义(P<0.05),术后残余肿瘤组织介于前两者之间但差异无统计学意义.结论 DWI可以评价肝癌TACE术后肿瘤组织的残余、坏死、复发情况,能为肝癌患者的治疗和随访提供有价值的影像学信息.

Evaluation of the effect of transcatheter arterial chemoembolization in treatment of primary hepatocellular carcinoma with magnetic resonance diffusion-weighted imaging:4-6-week follow-up of 25 cases

Objective To investigate the value of MR diffusion-weighted imaging (DWI) in evaluating the efficacy of treatment of primary hepatecellular carcinoma (HCC) by transcatheter arterial chemuembolization (TACE). Methods Twenty-five HCC patients, 19 males and 6 females, aged 54, underwent TACE. Conventional T1WI, T2WI, and DWI and dynamic enhanced MRI were conducted before the first TACE and after every TACE procedure for 4-6 weeks. The differences in the mean apparent diffusion coefficient (ADC) value of the remaining tumor, coagulation tumor necrotic tissue, and post-operative recurrent tumor tissue were compared and analyzed. Results When the b value was 1000 s/mm2 , the ADC values of the liver tissue, tumor tissue before first TACE, remaining tumor, coagulation tumor necrotic tissue, and post-operative recurrent tumor were 1.25 ±0.07, 1.02±0.19, 1.06 ±0.14, 1.68 ± 0.32, and 1.28±0.07 mm· s-1 ·10-3 respectively. The ADC value of the coagulation tumor necrotic tissue was significantly higher than those of the other tissues (F=23.25 ,P <0 05). The ADC values of the tumor tissue before the first TACE was the lowest, and the ADC value of the post-operative recurrent tumor was significantly higher than that of the tumor tissue before the first TACE (P< O.05). The ADC value of the remaining tumor tissue was between that of the post-operative recurrent tumor and that of the tumor tissue before the first TACE, however, without significant differences among them. Conclusion This study is the first relatively long-term follow-up study of the value of TACE in HCC treatment with DWL DWI can differentiate the remaining tumor, necrosis of tumor, and recurrence of tumor in HCC after TACE. It helps provide valuable imaging information for treatment and follow-up of the HCC patients.