肝癌经导管动脉灌注化疗栓塞术疗效的MR 扩散加权成像动态研究

肝癌经导管动脉灌注化疗栓塞术疗效的MR 扩散加权成像动态研究
尚全良 肖恩华 贺忠 谭利华 司徒卫军 白末了 袁术文 杜万平
【摘要】 目的 探讨MR 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
效动态评价中的作用。方法 在1. 5 T GE Signa Twin speed MR 机上, 取扩散敏感梯度因子( b 值) 为0
及800 s /mm2 , 利用固定参数组合的自旋回波-平面回波( SE-EPI) 序列对首次行TACE 治疗的25 例肝
癌肿块分别于术前24 ～48 h、术后36 ～48 h、术后7 ～10 d、术后30 ～38 d 内各进行1 次DWI, 对每次
的图像进行后处理, 计算出每例肝癌每个时点的表观扩散系数( ADC 值) , 对各个时点的ADC 值进行
对比研究, 并结合第1 次TACE 术后与第2 次TACE 术前肿瘤的血管造影染色及碘油沉积的改变判
断肿瘤的复发情况。结果 术前24 ～48 h、术后36 ～48 h、术后7 ～10 d、术后30 ～38 d 组的ADC 值
分别为( 1. 376 ±0. 012)× 10 - 3mm2 / s、( 1. 598 ±0. 012)× 10 - 3 mm2 / s、( 1. 723 ±0. 012)× 10 - 3 mm2 / s、
( 1. 684 ±0. 012)× 10 - 3mm2 / s。术后各组肝癌组织的ADC 值较术前明显升高( P < 0. 05) ; 术后7 ～
10 d、术后30 ～38 d 组的ADC 值较术后36 ～48 h 组明显升高( P < 0. 05) ; 术后30 ～38 d 的ADC 值较
术后7 ～10 d 组明显降低( P < 0. 05) 。将第1 次TACE 术后与第2 次TACE 术前的造影片及碘油沉积
片对比见术后30 ～38 d ADC 值下降的肝癌病例都有不同程度的复发, ADC 值下降明显的复发也最
为明显。结论 利用MR DWI 技术对肝癌组织的ADC 值进行动态观察, 可以评价肝癌TACE 术后癌
组织的坏死、复发情况。
【关键词】 癌, 肝细胞; 磁共振成像; 扩散; 化疗栓塞, 治疗性
Dynamic study of efficacy of tr ansca thet er a rter ial chemoembolization ( TACE) of pr imar y liver
car cinoma with the MR diffusion-weight ed ima ging ( DWI ) SHANG Quan-liang, XIAO En-hua, HE
Zhong, TAN Li-hua, SITU Wei-jun, BAI Mo-liao, YUAN Shu-wen, DU Wan-ping. Depa rtment of
Radiology, the Second Xiangya Hospital, Central South University, Changsha 410011, China
Corresponding author: XIAO En-hua , Email: cjr. xiaoenhua@vip. 163. com
【Abst ract】 Objective To dynamically evaluate the efficacy of treatment of primary liver carcinoma
( PLC) by transcatheter arterial chemoembolization( TACE) with the MR diffusion-weighted imaging( DWI) .
Methods DWI and the measurement of mean apparent diffusion coeffecient( ADC) value were performed in
25 masses of PLC with the same SE-EPI sequence ( b = 800 s /mm2 and 0) at 1. 5 T MRI within the 24—
48 hours before TACE ( group A) and 36—48 hours, 7—10 days, 30—38 days after TACE ( group B, group
C, group D) . The differences of the mean ADC values of PLC between groups were analyzed. Results The
mean ADC values of the three groups after TACE the mean ADC value of group B: ( 1. 598 ±0. 012 ) ×
10 - 3mm2 / s, the mean ADC value of group C: ( 1. 723 ±0. 012 )× 10 - 3 mm2 / s, the mean ADC value of
group D: ( 1. 684 ±0. 012)× 10 - 3 mm2 / s were significantly greater than that of the group before TACE the
mean ADC value of group A: ( 1. 376 ±0. 012) × 10 - 3 mm2 / s ( P < 0. 05) . The mean ADC values of the
group C and the group D were significantly greater than that of the group B ( P < 0. 05 ) . The mean ADC
values of the group D was lower than that of the group C ( P < 0. 05 ) . Through contrasting the digital
subtraction angiography ( DSA) imaging of the second TACE with that of the first TACE, we found that every
PLC whose mean ADC value after 30—38 days of the TACE was lower than that after 7—10 days of the
TACE could be found the recurrence, especially in those PLC whose mean ADC values were decreased
greatly. Conclusion With the measurement of ADC value of the different time of the PLC we could
excellently evaluate the necrosis and the recurrence of the PLC after the operation of the TACE.
【Key words 】 Carcinoma, hepatocellular; Magnetic resonance imaging; Diffusion;