动态对比增强磁共振成像对原发性肝癌的评估应用

Preliminary clinical study of primary liver cancer using 3 Tesla dynamic enhanced MR imaging

目的动态对比增强磁共振成像(dynamic contrast enhanced magnetic resonance imaging,DCE-MRI)是一种新的用来评估组织血管性质的功能磁共振成像方法。文中旨在探讨DCE-MRI在血管渗透性层面反映肝癌组织的血管生成情况,从而为肝癌的评估提供更客观的诊断信息。方法对21例临床或病理诊断为原发性肝癌的患者进行DCE-MRI,按选取位置不同将感兴趣区分为整个肿瘤、肿瘤热点和肿瘤周围肝组织3组。应用Tissue 4D软件包对DCE-MRI图像进行后处理,得到下列定量参数:转运常数(Ktrans)、速率常数(Kep)、肿瘤血管外细胞外间隙体积分数(Ve)及半定量参数对比剂浓度-时间曲线下初始面积(initial area under the contrast concentration versus time curve,iAUC)。结果肿瘤周围肝组织的平均Ktrans、Kep、Ve及iAUC分别为(0.124±0.057)/min、(0.632±0.158)/min、(0.205±0.098)和(10.009±6.201),整个肿瘤分别为(0.196±0.109)/min、(0.546±0.214)/min、(0.424±0.160)和(13.675±6.113),肿瘤热点分别为(0.422±0.170)/min、(0.780±0.308)/min、(0.589±0.116)和(35.663±19.086)。肿瘤热点各项参数均高于整个肿瘤,差异均具有统计学意义(P<0.05);整个肿瘤的Ktrans、Ve及iAUC值均高于肿瘤周围肝组织,2组间Ktrans、Ve差异具有统计学意义(P<0.05);肿瘤周围肝组织的各项参数均明显低于肿瘤热点,除Kep外差异均具有统计学意义(P<0.05)。结论应用DCE-MRI参数分析组织微血管的渗透性,间接反映肿瘤血管的生成情况,对原发性肝癌的评估有一定的帮助。监测肿瘤热点的各项DCE-MRI参数,对原发性肝癌的评估可能会更加准确。

Objective Dynamic contrast enhanced magnetic resonance imaging （DCE-MRI） is a novel functional imaging tech-nique for assessing the property of the tissue vessel .This study was to investigate whether DCE-MRI can manifest the angiogenesis of pri-mary liver cancer in the aspect of vascular permeability so as to provide more objective diagnostic information for the evaluation of primary liver cancer . Methods Twenty-one patients with primary liver cancer underwent DCE-MRI.The region of interest （ ROI） was placed in the whole tumor, the hot spot of the tumor and the adjacent liver parenchyma .Tissue 4D software package was used for the post-pro-cessing of the DCE-MRI images, the quantitative parameters including transfer constant （Ktrans）, rate constant （Kep） and tumor extravas-cular extracellular space volume （Ve）, and such semi-quantitative parameter as the initial area under the contrast concentration versus time curve （iAUC）. Results The mean Ktrans, Kep, Ve and iAUC values were （0.124 ±0.057）/min, （0.632 ±0.158）/min, （0.205 ±0.098） and （10.009 ±6.201） in the adjacent liver parenchyma , （0.196 ±0.109）/min, （0.546 ±0.214）/min, （0.424 ± 0.160） and （13.675 ±6.113） in the whole tumor, and （0.422 ±0.170）/min, （0.780 ±0.308）/min, （0.589 ±0.116） and （35.663 ±19.086） in the hot spot of the tumor .All the parameters were significantly higher in the hot spot of the tumor than in the whole tumor （P〈0.05）, and so were Ktrans and Ve in the whole tumor than in the adjacent liver parenchyma （P〈0.05）, but Ktrans, Ve, and iAUC were markedly lower in the adjacent liver parenchyma than in the hot spot of the tumor （P〈0.05）. Conclusion Analysis of the vascular permeability of the tissue using DCE-MRI parameters can indirectly reflect the angiogenesis of the tumor and contribute to the evaluation of primary liver cancer , while monitoring the DCE-MRI pa-rameters of the hot spots of the tumor may allow more accurate evalua-tion of primary liver cancer .