MRI对肝癌TACE术后疗效评估的价值

The Value of MRI on the Postoperative efficacy of TACE

目的探讨1.5T MRI对评价原发性肝细胞肝癌介入治疗后疗效的价值。方法回顾性分析2014年11月到2015年12月25例经TACE治疗的原发性肝细胞肝癌患者,所有患者TACE术前3天内及术后1个月即第2次TACE术前行常规MRI、DWI(b=800)序列扫描及MR动态增强扫描。通过与DSA结果对照分析,观察病灶在DWI(b=800)序列信号特点及ADC值、动态增强扫描时间信号曲线特点、MRI信号表现。结果 25个术后碘油沉积区ADC值较术前瘤区病灶明显升高;磁共振动态增强扫描未见明显强化;T1WI及T2WI以低信号为主,局部信号混杂。22个液化坏死区ADC值较术前瘤区病灶显著升高,磁共振动态增强扫描18个未见明确强化,4个动脉期未见强化,延迟局部强化;T1WI为低信号,T2WI为高信号。残留复发区,大部分位于介入术后病灶内部,ADC值较术前瘤区病灶无明显变化,磁共振动态增强扫描17个呈速升速降型为主,大部分为短T1WI长T2WI高信号。部分环形均匀强化9个后期随访消失,为炎性反应。结论 1.5T MRI可较准确分析瘤区TACE术后坏死灶与复发残留灶信号变化特点,可用于TACE早期疗效的评价。

Objective To value the effect of primary liver carcinoma after the operation by TACE using the 3.0 T MRI.Methods Analyze retrospectively 25 cases of primary hepatic carcinoma patients which of them must review regular MRI,DWI（b=800）scanning and MR dynamic increase 3 days before operation and 1 month after operation.Through and late follow-up,part of the DSA and CT enhanced scan findings were observed preoperative tumor area,lipiodol deposition area,tumor necrosis,areas of tumor recurrence in the DWI（b=800） signal characteristics and ADC values,dynamic enhanced scanning time signal curve,MRI signal characteristics,so as to analyze the tumor necrosis and recurrence.Results 25 lipiodol deposition area ADC value compared with preoperative tumor lesion area increased significantly,dynamic contrast enhanced MRI showed no strengthening.T1WI and T2WI low signal-based,local mixed signals.22 liquefaction necrosis ADC value was significantly higher compared with that before the tumor lesion area,dynamic contrast enhanced MRI 18 no clear enhancement,no enhancement in the arterial phase 4,delay local strengthening;T1WI low signal,T2WI high signal.The residue remaining relapse region,mostly in internal lesions after intervention,ADC value compared with preoperative tumor lesion area was no significant change in dynamic contrast enhanced MRI showed a 17 liter downhill speed main type,most of the short length T1WI T2WI high signal.Portion of the annular homogeneous enhancement nine late follow-up disappears,the inflammatory response Conclusion Dynamic MRI scan combined with DWI can accurately analyze the tumor necrosis after TACE lesion and recurrence characteristics of residues focal signal change,can be used to evaluate the effect of early TACE.