磁共振扩散加权成像在肝细胞癌肝动脉化疗栓塞术后疗效监测中的价值

Study on the value of MR diffusion weighted imaging in treatment effectiveness monitoring after arterial chemoembolization for hepatocellular carcinoma

目的探讨磁共振扩散加权成像在肝细胞癌肝动脉化疗栓塞术后疗效监测中的价值。方法选择该院收治的肝癌TACE患者28例。所有患者均同期进行上腹部磁共振扩散加权成像和DSA血管造影检查。统计新发病灶数目,计算DWI、T2WI中同时观察到的新发肿瘤病灶与周围肝组织比较的信噪比(SNR),分析碘化油沉积区、肿瘤坏死区以及肿瘤复发或残留区在DWI图像上的信号特点。结果新发病灶特点:在T1WI表现为低信号,在T2WI表现为较高信号,在DWI表现为高信号。与T2WI比较,新发病灶在DWI上SNR明显提高,差异具有统计学意义(P<0.05)。通过对CT、DSA以及DWI的综合分析,TACE术后病灶内部的缺血坏死区,DWI上表现为低信号;而肿瘤活性组织区,DWI上表现高信号;而碘油沉积区域在DWI上信号则较复杂,低信号、等信号和稍高信号均有表现。结论磁共振扩散加权成像对患者无损伤,方法简便,其对于肝细胞癌肝动脉化疗栓塞术后新发病灶的检查较为敏感,且能够对肿瘤活性组织和坏死组织进行准确的区分,适于在患者术后疗效评价的监测中广泛应用。

[ Objective ] To probe the value of MR diffusion weighted imaging in treatment effectiveness monitoring after arterial chemoembolization for hepatocellular carcinoma. [Methods] From June 2012 to January 2015, 28 hepatocellular carcinoma patients after TACE were selected in our hospital. All the patients were underwent MR diffusion weighted imaging and DSA angiography for upper abdominal during the same period. Statistics of the number of new lesions, compute of the new tumor and surrounding liver tissue lesions were observed in DWI, T2WI simultaneously, and compared to noise ratio （SNR）, analysis of the iodized oil deposition zone, tumor necrosis and tumor recurrence or residual area in DWI signal characteristic image. [Results] The characteristics of new lesion： in T1WI showed low signal, in T2W! showed high signal, in DWI showed high signal. Compared with T2WI, the SNR of new lesions on DWI were increased significantly, the difference were significant statistically （P 〈 0.05）. Through a comprehensive analysis of CT, DSA and DWF, after TACE, the ischemic necrosis area in lesions showed low signal in DWI, the tumor tissue activity area showed high signal in DWI, lipiodol deposition area signal in DWI was complex, included low signals, equal signals, and high signals. [ Conclusion ] MR diffusion weighted imaging is a method with non-invasive in patients and simple. It is more sensitive in checking new lesions for hepatocellular carcinoma patients after arterial chemoembolization, and distinguishing of tumor tissue and necrotic tissue accurately. It is suitable widely used for monitoring evaluation of postoperative patient.