磁共振弥散加权成像和动态增强成像对肝癌经导管动脉化疗栓塞的疗效评价

Evaluation on the therapeutic effect of transcatheter arterial chemoembolization in hepatocellular carcinoma with DWI and dynamic contrast-enhanced MR imaging

目的探讨DWI和动态增强成像（DCEI）在评价经导管动脉化疗栓塞术（TACE）治疗肝细胞癌（HCC）疗效中的作用。方法收集TACE前及TACE后4~6周接受常规MR、DWI及DCEI检查的HCC患者20例（39个病灶）,比较TACE前后各病灶大小、ADC值、动脉期和门脉期相对强化率（rER）的差异,分析TACE后ADC值下降/升高与动脉期或门脉期rER升高/下降之间的一致性。结果 TACE后病灶的直径[（6.61±3.22）cm]较TACE前[（6.26±3.17）cm]增大（P〈0.001）,ADC值[（1.27±0.29）×10-3mm2/s]较TACE前[（1.17±0.30）×10-3mm2/s]升高（P=0.003）。动脉期rER（0.69±0.38）与TACE前（0.73±0.48）差异无统计学意义（P=0.655）,门脉期rER（1.21±0.36）与TACE前（1.27±0.37）的差异无统计学意义（P=0.451）。TACE后病灶ADC值的下降/升高与动脉期rER的升高/下降不一致（P=0.001）,与门脉期rER的升高/下降保持一致（P=0.118）。TACE后门脉期rER升高病灶的ADC值[（1.29±0.28）×10-3mm2/s]与TACE前[（1.24±0.21）×10-3mm2/s]差异无统计学意义（P=0.255）;TACE后门脉期rER下降病灶的ADC值[（1.26±0.30）×10-3mm2/s]较TACE前[（1.12±0.34）×10-3mm2/s]升高（P=0.004）。结论 HCC病灶的ADC值与其门脉期血流灌注存在一定的关系,可用于评价TACE治疗HCC的疗效。

Objective To evaluate the efficacy of transcatheter arterial chemoembolization（TACE） in treatment of hepatocellular carcinoma（HCC） with DWI and dynamic contrast-enhanced imaging（DCEI）.Methods DWI and DCEI were performed before and 4—6 weeks after TACE in 20 patients with 39 HCC lesions.Tumor size,ADC values and relative enhancement rate（rER） of arterial and portal venous phases were compared before and after treatment.The agreement of decrease/increase of ADC value and increase/decrease of rER of arterial or portal venous phase was analyzed.Results The mean tumor diameter increased from（6.26±3.17）cm to（6.61±3.22）cm after TACE（P0.001）.Tumor ADC value increased significantly from（1.17±0.30）×10-3 mm2/s to（1.27±0.29）×10-3 mm2/s（P=0.003）.There was no statistical difference between rER of arterial（from 0.69±0.38 to 0.73±0.48） or portal venous phase（from 1.21±0.36 to 1.27±0.37） before and after TACE（P=0.655,0.451）.The decrease/increase of ADC value was not coincident with increase/decrease of rER of arterial phase（P=0.001）,but was coincident with increase/decrease of rER of portal venous phase（P=0.118）.For lesions with increased rER of portal venous phase,the ADC value before TACE（[1.24±0.21]×10-3 mm2/s） had no difference with that after TACE（[1.29±0.28]×10-3 mm2/s）（P=0.255）.For lesions with decreased rER of portal venous phase,the ADC value increased significantly from（1.12±0.34）×10-3 mm2/s to（1.26±0.30）×10-3 mm2/s after TACE（P=0.004）.Conclusion ADC value may be a useful tool in the assessment of HCC response to TACE.It is related to the perfusion effect of portal venous phase to some extent.