磁共振弥散加权成像联合动态增强在肝癌患者TACE术后病灶残留及复发监测中的应用价值

Diffusion weighted imaging combined with dynamic contrast enhanced magnetic resonance imaging in monitoring therapeutic efficacy for hepatocellular carcinoma after transcatheter arterial chemoembolization

目的：探讨磁共振弥散加权成像（DWI）联合动态增强监测肝癌患者经导管动脉化疗栓塞术（TACE）治疗后肿瘤变化的临床价值.方法：收集TACE术后4～6周同时接受MRI和CT增强扫描的肝癌患者31例,以TACE术后再次数字血管减影造影（DSA）肿瘤染色为标准,分析MRI和CT两种检查方式对TACE治疗后肿瘤残留及复发的诊断价值.结果：31例TACE术后复查患者中,MRI和CT两种检查方式共检出病灶73个,DSA证实其中14个病灶阴性,59个病灶阳性,CT动态增强诊断的敏感性为78.0%,特异性为85.7%,磁共振DWI联合动态增强诊断的敏感性为100%,特异性为92.9%,两种检查方法对病灶检出率的差异有统计学意义（P〈0.001）.结论：磁共振DWI联合动态增强监测肝癌TACE术后残留及复发的价值优于CT增强,而且不存在电离辐射,可以作为TACE术后监测病灶残留及复发的首选方法.

Objective： To evaluate the diagnostic value of diffusion weighted imaging （DWI） combined with dynamic contrast-enhanced （DCE）MRI in monitoring the efficacy for hepatocellular carcinoma （ HCC ） chemoembolization （TACE）. Methods： MRI and CT after transcatheter arterial scan were performed 4-6 weeksafter TACE in 31 patients. With digital signature algorithm （DSA） examination as the reference standard, the value in detection of the residue and recurrence of HCC was compared between MRI and CT results. Results： Seventy-three lesions were detected in 31 patients. Fourteen lesions confirmed by DSA had no tumor staining, and 59 lesions had tumor staining. Diagnostic sensitivity and specificity of DCE-CT were 78.0% and 85.7% ,respectively; while those of DWI combined with DCE-MRI were 100% and 92.9% （P 〈 0. 001 ）. Condusi0n： DWI combined with DCE-MRI is more effective than DCE-CT in detecting the residue and recurrence of HCC after TACE.