• 宜賓市第二人民醫(yī)院（四川宜賓，644000）1放射科，2預(yù)防保健科，3腫瘤科;

【摘要】　目的　 探討磁共振動(dòng)態(tài)增強(qiáng)掃描及磁共振彌散加權(quán)成像（diffusion weighted imaging，DWI）對(duì)肝癌經(jīng)導(dǎo)管動(dòng)脈內(nèi)化學(xué)栓塞（transcatheter arterial chemoembolization，TACE）治療后的腫瘤殘余及復(fù)發(fā)的判斷價(jià)值。　方法　 2009年1月-2010年10月，對(duì)28例經(jīng)證實(shí)的肝癌患者在TACE治療前、治療后3~7 d及治療后1~2個(gè)月、3~6個(gè)月行磁共振動(dòng)態(tài)增強(qiáng)及DWI掃描，動(dòng)態(tài)測量表觀彌散系數(shù)（apparent diffusion coefficient，ADC）值，與數(shù)字減影血管造影（digital substraction angiography，DSA）檢查對(duì)照，評(píng)價(jià)動(dòng)態(tài)增強(qiáng)掃描及DWI對(duì)腫瘤殘留或復(fù)發(fā)的檢出能力。〖HTH〗結(jié)果　對(duì)腫瘤殘余及復(fù)發(fā)的顯示，動(dòng)態(tài)增強(qiáng)掃描靈敏度為90.0%，特異度為96.9%；DWI靈敏度為96.7%，特異度為93.8%；動(dòng)態(tài)增強(qiáng)掃描與DWI相結(jié)合的靈感度為100.0%，特異度為99.5%；DSA靈敏度和特異度分別為96.7%、100.0%。TACE治療前所有腫瘤實(shí)質(zhì)的ADC值為（1.134±0.014）×10-3 mm2/s；TACE治療后3~7 d ADC值為（1.162±0.016）×10-3 mm2/s；TACE治療后1~2個(gè)月碘油沉積較好，無明顯殘余或復(fù)發(fā)病灶的ADC值為（1.175±0.015）×10-3 mm2/s，3~6個(gè)月后隨訪病灶A(yù)DC值為（1.179±0.017）×10-3 mm2/s；TACE治療后1~2個(gè)月碘油沉積不完全或無明顯沉積病灶A(yù)DC值為（1.147±0.016）×10-3 mm2/s，3~6個(gè)月后隨訪病灶實(shí)質(zhì)平均ADC值（1.142±0.012）×10-3 mm2/s。　結(jié)論　 將動(dòng)脈增強(qiáng)掃描與DWI相結(jié)合可提高對(duì)TACE治療后肝癌殘余及復(fù)發(fā)判斷的靈敏度及特異度；對(duì)腫瘤組織平均 ADC值的動(dòng)態(tài)測量、觀察可及早判斷腫瘤復(fù)發(fā)的可能性。
【Abstract】　Objective　 To evaluate the dynamic contrast-enhanced MRI and diffusion weighted imaging (DWI) in judging the remnant and recurrence on hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE). 　Methods　 Between January 2009 and October 2010, 28 patients with HCC underwent dynamic contrast-enhanced MRI and DWI before and after TACE 3-7 days, 1-2 months and 3-6 months, respectively, and the apparent diffusion coefficient (ADC) value of the tumor were also measured at above mentioned time points. The sensitivity and specificity of dynamic contrast-enhanced MRI and DWI in diagnosis of residual tumor and recurrent cancer was qualitatively evaluated by comparing with the DSA results.　Results　 Compared with DSA, the sensitivity and specificity of dynamic contrast-enhanced MRI were 90.0% and 96.9% by revealing the remnant and recurrence of HCC, while the sensitivity and specificity of DWI were 96.7% and 93.8% respectively. Combining dynamic contrast-enhanced MRI and DWI the sensitivity and specificity were improved to 100.0% and 99.5%, respectively. The mean ADC value of tumor before and after 3-7 days of TACE were (1.134±0.014)×10-3 and (1.162±0.016)×10-3 mm2/s, respectively. The mean ADC value of tumor without and with remnant and recurrence after 1-2 months and 3-6 months follow up were (1.175±0.015)×10-3, and (1.179±0.017)×10-3 mm2/s; (1.147±0.016)×10-3 and (1.142±0.012)×10-3 mm2/s, respectively.　Conclusions　 Combining dynamic contrast-enhanced MRI and DWI could improve the sensitivity and specificity to detect the remnant and recurrence of HCC after TACE. Measuring the ADC value during follow up of HCC patients after TACE could predict the probability of tumor recurrence.

引用本文： 邱麗華,曹躍勇,朱建軍,袁志平,朱軍,敖永勝,刁顯明. 磁共振動(dòng)態(tài)增強(qiáng)掃描及彌散加權(quán)成像對(duì)肝癌肝動(dòng)脈化學(xué)栓塞治療的療效判斷. 華西醫(yī)學(xué), 2011, 26(9): 1351-1355. doi: 復(fù)制

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3. 　Geschwind JF, Artemov D, Abraham S, et al. Chemoembolization of liver tumor in a rabbit model: assessment of tumor cell death with diffusion-weighted MR imaging and histologic analysis[J]. J Vasc Interv Radiol, 2000, 11(10): 1245-1255.
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5. 　Chung JC, Naik NK, Lewandowski RJ, et al. Diffusion-weighted magnetic resonance imaging to predict response of hepatocellular carcinoma to chemoembolization[J]. World J Gastroenterol, 2010, 16(25): 3161-3167.
6. 　Briot K, Gossec L, Kolta S, et al. Prospective assessment of body weight, body composition, and bone density changes in patients with spondyloarthropathy receiving anti-tumor necrosis factor-alpha treatment[J]. J Rheumatol, 2008, 35(5): 855-861.
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10. 　Castrucci M, Sironi S, De Cobelli F, et al. Plain and gadolinium-DTPA-enhanced MR imaging of hepatocellular carcinoma treated with transarterial chemoembolization[J]. Abdom Imaging, 1996, 21(6): 488-494.
11. 　Liapi E, Geschwind JF, Vossen JA, et al. Functional MRI evaluation of tumor response in patients with neuroendocrine hepatic metastasis treated with transcatheter arterial chemoembolization[J]. AJR Am J Roentgenol, 2008, 190(1): 67-73.
  1. 1. 　Sturm JW, Keese MA, Bonninghoff RG, et al. Locally ablative therapies of hepatocellular carcinoma[J]. Onkologie, 2001, 24(Suppl 5): 35-45.
  2. 2. 　Geschwind JF, Ramsey DE, Cleffken B, et al. Transcatheter arterial chemoembolization of liver tumors: effects of embolization protocol on injectable volume of chemotherapy and subsequent arterial patency[J]. Cardiovasc Intervent Radiol, 2003, 26(2): 111-117.
  3. 3. 　Geschwind JF, Artemov D, Abraham S, et al. Chemoembolization of liver tumor in a rabbit model: assessment of tumor cell death with diffusion-weighted MR imaging and histologic analysis[J]. J Vasc Interv Radiol, 2000, 11(10): 1245-1255.
  4. 4. 　Chen CY, Li CW, Kuo YT, et al. Early response of hepatocellular carcinoma to transcatheter arterial chemoembolization: choline levels and MR diffusion constants--initial experience[J]. Radiolog, 2006, 239(2): 448-456.
  5. 5. 　Chung JC, Naik NK, Lewandowski RJ, et al. Diffusion-weighted magnetic resonance imaging to predict response of hepatocellular carcinoma to chemoembolization[J]. World J Gastroenterol, 2010, 16(25): 3161-3167.
  6. 6. 　Briot K, Gossec L, Kolta S, et al. Prospective assessment of body weight, body composition, and bone density changes in patients with spondyloarthropathy receiving anti-tumor necrosis factor-alpha treatment[J]. J Rheumatol, 2008, 35(5): 855-861.
  7. 7. 　Goshima S, Kanematsu M, Kondo H, et al. Evaluating local hepatocellular carcinoma recurrence post-transcatheter arterial chemoembolization: is diffusion-weighted MRI reliable as an indicator ? [J]. J Magn Reson Imaging, 2008, 27(4): 834-839.
  8. 8. 　袁正, 董生, 許立超, 等. 磁共振擴(kuò)散加權(quán)成像在肝癌化療栓塞術(shù)后隨訪中的臨床應(yīng)用[J]. 臨床放射學(xué)雜志, 2009, 28(6): 821-824.
  9. 9. 　尚全良, 肖恩華, 賀忠, 等. 肝癌經(jīng)導(dǎo)管動(dòng)脈灌注化療栓塞術(shù)療效的MR擴(kuò)散加權(quán)成像動(dòng)態(tài)研究[J]. 中華放射學(xué)雜志, 2006, 40(3): 235-240.
  10. 10. 　Castrucci M, Sironi S, De Cobelli F, et al. Plain and gadolinium-DTPA-enhanced MR imaging of hepatocellular carcinoma treated with transarterial chemoembolization[J]. Abdom Imaging, 1996, 21(6): 488-494.
  11. 11. 　Liapi E, Geschwind JF, Vossen JA, et al. Functional MRI evaluation of tumor response in patients with neuroendocrine hepatic metastasis treated with transcatheter arterial chemoembolization[J]. AJR Am J Roentgenol, 2008, 190(1): 67-73.