^(31)P-MR波谱分析技术评价化疗栓塞治疗肝细胞癌疗效的初步研究

Value of ^(31)P MR spectroscopy in monitoring the early response of hepatocellular carcinoma to transcatheter arterial chemoembolization

目的评价MR磷谱分析(31P-MRS)早期监测肝细胞癌(HCC)化疗栓塞治疗疗效的价值。方法对15例因HCC接受化疗栓塞治疗的患者(共17个癌灶)分别在治疗前和治疗后48h内进行31P-MRS检查,5名健康志愿者也接受相同参数的检查以作为对照。比较肝癌组织和正常肝组织中的磷酸单酯(PME)和磷酸二酯(PDE)水平;分别计算化疗栓塞前后PME、PDE、与三磷酸核苷比值(PME/NPT)、PDE/NPT,并对治疗前、后数据进行统计学处理。与临床随访资料比较,考量各指标在早期评价疗效中的价值。结果HCC治疗后PME水平(中位数:1.38×107;范围:0.665×107～6.21×107)低于治疗前(中位数:2.98×107;范围:0.846×107～102.5×107)(P<0.05)。临床随访发现治疗有效病灶31P-MRS中,治疗后48h内与治疗前相比PME/NPT(P<0.01)和PME/PDE/NPT(P<0.01)比值均下降;临床随访中治疗无效的病灶,PME/NPT比值下降(P<0.05),而PDE/NPT比值轻度上升,但差异无统计学意义(P<0.05)。结论在肝细胞肝癌化疗栓塞治疗前和治疗后48h内,31P-MRS中PME/NPT和PDE/NPT的比值变化对早期评价疗效和指导后续治疗有指导意义。

Objective To evaluate the value of ^31p MR spectroscopy in monitoring the early response of hepatocellular carcinoma to chemoembolization. Methods ^31p-MR spectra of HCC obtained before and within 48 h after chemoembolization in 15 HCC patients with 17 lesions. A control group of five adults with normal livers was examined through the same protocol. The median and range of the phosphomonoester （PME）and phosphodiester （PDE） levels in HCCs and in the control subjects were calculated and compared. The median and range of the PME and PDE levels, the ratio of phosphomonoester to nucleoside triphosphate （PME/NPT）, and phosphodiester to nucleoside triphosphate（PDE/NPT） in HCC before and after TACE were calculated seperately. For statistical analysis, the two-tailed paired t-test was applied. Alterations of phosphorus metabolism before and after TACE were compared with tumor response evaluated by means of long-term follow-up. Results Chemoembolization induced decrease of the PME level （P 〈 0.05） as well as the ratio of PME/NPT（P 〈 0.01 ） within 48 h. Responding lesions had a significant decrease in the ratio of PDE/NPT declined within 48 h after chemoembolization （P 〈 0.01 ）; But no significant change was observed in nonresponding HCC lesions （P 〉 0.05）. Conclusions The ratios of PME/NPT and PDE/NPT of ^31p-MRS may provide the monitor of therapeutic early responses of hepatocellular carcinoma to chemoembolization, although yet the larger, more definitive and quantitative studies are needed clinically.