磁共振DWI序列及表观扩散系数值动态评估原发性肝癌介入疗效的应用价值

The application of MR DWI sequences and apparent diffusion coefficient values in dynamic evaluation of the efficacy of transcatheter arterial chemoembolization for primary hepatocellular carcinoma

目的探讨利用磁共振DWI序列及表观扩散系数(ADC)值动态评估原发性肝癌介入治疗疗效的价值。方法对介入治疗前、后的患者进行常规MRI、动态增强及DWI序列(弥散梯度因子b=0、200、500、800s/mm2)扫描,测量0～500的ADC值,并与血管造影、血清生化对比。结果介入治疗后肿瘤的ADC值较术前增高,疗效好的ADC值>疗效中等的ADC值,与术前比较均有统计学意义,疗效差的ADC值与术前差异无统计学意义;随访显示ADC值无明显降低的为疗效好的病例,疗效中等和差的ADC值出现降低,增强MRI、DWI序列、血管造影可显示癌细胞存活、复发。结论 DWI序列和ADC值可以动态观察原发性肝癌介入治疗后癌细胞是否坏死、存活和复发,可及时有效的评估介入治疗疗效。

Objective To discuss the value of MR diffusion-weighted imaging （DWI） sequences and apparent diffusion coefficient （ADC） values in dynamically assessing the therapeutic efficacy of transcatheter arterial chemoembolization for primary hepatocellular carcinoma. Methods Routine MRI,dynamic contrastenhanced and DWI （b = 0,200,500 and 800 s / mm^2） were performed in patients with primary hepatocellular carcinoma both before and after they received transcatheter arterial chemoembolization treatment. The ADC values of 0 -500 were measured,and the results were compared with the angiographic and biochemical findings. Results After the interventional treatment the ADC value was increased. The postoperative ADC value in patients with better results was higher than that in patients with moderate effectiveness. In the above patients the difference between preoperative ADC value and postoperative ADC value was statistically significant （P 〈0.05）. While in patients presenting poor effectiveness the postoperative ADC value was not significantly different from preoperative ADC value. During the follow-up period ADC value showed no marked reduction in patients with good therapeutic efficacy,while an obvious decrease in ADC value was observed in patients with moderate or poor efficacy. Enhanced MRI,DWI sequences and angiography clearly demonstrated the survival sites and relapse of the tumor cells. Conclusion DWI and ADC value can dynamically reflect the necrosis,survival and recurrence of the primary hepatocellular carcinoma after interventional therapy,which is very useful for promptly and effectively evaluating the therapeutic efficacy.