体素内不相干运动扩散加权成像在肝癌介入治疗预后中的价值

Value of intravoxel incoherent motion diffusion weighted imaging(IVIM-DWI) in prediction of prognosis of hepatocellular carcinoma after transcatheter arterial chemoembolization

目的:探讨MR体素内不相干运动扩散加权成像(intravoxel incoherent motion diffusion weighted imaging,IVIM-DWI)指标预测肝细胞肝癌(hepatocellular carcinoma,HCC)经动脉化疗栓塞(transcatheter arterial chemoembolization,TACE)后无进展生存期(progression-free survival,PFS)的价值。方法:收集2014年9月30日—2017年9月30日于北京协和医院肿瘤医院诊治的90例肝癌患者,在治疗前及治疗后4~6周内分别行IVIM-DWI检查。将性别、年龄、病变长径、瘤栓有无、AFP、ALT值6个临床指标,治疗前ADC、D、D*、f值,以及治疗后ADC、D、D*、f值8个MR功能学定量指标进行多因素分析。采用独立样本t检验、方差分析及χ2检验,以Kaplan-Meier生存曲线、Log-Rank检验、多因素Cox回归分析确定有预后价值的IVIM参数及临床指标。结果:性别、年龄、治疗前D*值、治疗前f值及治疗后D*值共5个指标在肝癌TACE治疗后的PFS中差异具有统计学意义(P性别=0.030,P年龄=0.005,P治疗前D*<0.001,P治疗前f值=0.007,P治疗后D*<0.001)。即男性、高龄、高治疗前D*值、高治疗前f值及高治疗后D*值的患者预后差。以中位数为分界值,即年龄、治疗前D*值、治疗前f值和治疗后D*值4个指标分别以53岁、14.1×10-3 mm2/s、23.63%和11.9×10-3 mm2/s为界值,发现年龄及治疗前D*值2个指标预测预后的差异有统计学意义(P高龄组=0.027,P治疗前D*=0.003)。结论:年龄及治疗前D*值2个指标有助于预测肝癌TACE治疗的预后,即高龄、高治疗前D*值者预后更差。

Objective To predict the value of intravoxel incoherent motion diffusion weighted imaging（IVIM-DWI） in prediction of progression-free survival （PFS） of hepatocellular carcinoma （HCC） after transcatheterarterial chemoembolization （TACE）. Methods： Ninety patients were enrolled in this study from September 30th2014 to September 30th 2017. A total of 14 parameters including 6 clinical indexes： gender, age, size of lesion, tumorthrombus, AFP and ALT values; and 8 functional MRI indexes： pretreatment ADC, D, D＊, f, posttreatment ADC, D,D＊ and f were analyzed by multivariate analysis. Independent sample t test, ANOVA, Kaplan-Meier survival curve,Log-Rank test and Cox regression analysis were used to determinate the prognostic value of IVIM parameters andclinical indicators. Results： Gender, age, pretreatment D＊, f and posttreatment D＊ could predict the prognosis of HCCafter TACE （Pgender =0.030, Page =0.005, Ppretreatment D＊〈0.001, Ppretreatment f=0.007,Pposttreatment D＊〈0.001）. Using median（age=53 years, pretreatment D＊=14.1×10^-3 mm2/s, pretreatment f=23.63%, posttreatment D＊=11.9×10^-3 mm2/s） ascut-off value, age and pretreatment D＊ showed statistical significance in predicting the prognosis of HCC （Page =0.027,Ppretreatment D＊=0.003）. Conclusion： Age and pretreatment D＊ value can predict the prognosis of HCC after TACE.