磁共振动态增强扫描及弥散加权成像对肝癌肝动脉化学栓塞治疗的疗效判断

【】　目的　探讨磁共振动态增强扫描及磁共振弥散加权成像（diffusionweightedimaging，DWI）对肝癌经导管动脉内化学栓塞（transcatheterarterialchemoembolization，TACE）治疗后的肿瘤残余及复发的判断价值。　方法　2009年1月-2010年10月，对28例经证实的肝癌患者在TACE治疗前、治疗后3~7d及治疗后1~2个月、3~6个月行磁共振动态增强及DWI扫描，动态测量表观弥散系数（apparentdiffusioncoefficient，ADC）值，与数字减影血管造影（digitalsubstractionangiography，DSA）检查对照，评价动态增强扫描及DWI对肿瘤残留或复发的检出能力。〖HTH〗结果　对肿瘤残余及复发的显示，动态增强扫描灵敏度为90.0%，特异度为96.9%；DWI灵敏度为96.7%，特异度为93.8%；动态增强扫描与DWI相结合的灵感度为100.0%，特异度为99.5%；DSA灵敏度和特异度分别为96.7%、100.0%。TACE治疗前所有肿瘤实质的ADC值为（1.134±0.014）×10-3mm2/s；TACE治疗后3~7dADC值为（1.162±0.016）×10-3mm2/s；TACE治疗后1~2个月碘油沉积较好，无明显残余或复发病灶的ADC值为（1.175±0.015）×10-3mm2/s，3~6个月后随访病灶ADC值为（1.179±0.017）×10-3mm2/s；TACE治疗后1~2个月碘油沉积不完全或无明显沉积病灶ADC值为（1.147±0.016）×10-3mm2/s，3~6个月后随访病灶实质平均ADC值（1.142±0.012）×10-3mm2/s。　结论　将动脉增强扫描与DWI相结合可提高对TACE治疗后肝癌残余及复发判断的灵敏度及特异度；对肿瘤组织平均ADC值的动态测量、观察可及早判断肿瘤复发的可能性。【Abstract】　Objective　Toevaluatethedynamiccontrast-enhancedMRIanddiffusionweightedimaging(DWI)injudgingtheremnantandrecurrenceonhepatocellularcarcinoma(HCC)aftertranscatheterarterialchemoembolization(TACE).　Methods　BetweenJanuary2009andOctober2010,28patientswithHCCunderwentdynamiccontrast-enhancedMRIandDWIbeforeandafterTACE3-7days,1-2monthsand3-6months,respectively,andtheapparentdiffusioncoefficient(ADC)valueofthetumorwerealsomeasuredatabovementionedtimepoints.Thesensitivityandspecificityofdynamiccontrast-enhancedMRIandDWIindiagnosisofresidualtumorandrecurrentcancerwasqualitativelyevaluatedbycomparingwiththeDSAresults.　Results　ComparedwithDSA,thesensitivityandspecificityofdynamiccontrast-enhancedMRIwere90.0%and96.9%byrevealingtheremnantandrecurrenceofHCC,whilethesensitivityandspecificityofDWIwere96.7%and93.8%respectively.Combiningdynamiccontrast-enhancedMRIandDWIthesensitivityandspecificitywereimprovedto100.0%and99.5%,respectively.ThemeanADCvalueoftumorbeforeandafter3-7daysofTACEwere(1.134±0.014)×10-3and(1.162±0.016)×10-3mm2/s,respectively.ThemeanADCvalueoftumorwithoutandwithremnantandrecurrenceafter1-2monthsand3-6monthsfollowupwere(1.175±0.015)×10-3,and(1.179±0.017)×10-3mm2/s;(1.147±0.016)×10-3and(1.142±0.012)×10-3mm2/s,respectively.　Conclusions　Combiningdynamiccontrast-enhancedMRIandDWIcouldimprovethesensitivityandspecificitytodetecttheremnantandrecurrenceofHCCafterTACE.MeasuringtheADCvalueduringfollowupofHCCpatientsafterTACEcouldpredicttheprobabilityoftumorrecurrence.