放射性肝损伤患者肝脏磁共振扩散加权成像表现特征分析

Diagnostic value of diffusion-weighted magnetic resonance imaging in patients with radiation-induced liver injury with underlying hepatocelullar carcinoma

目的探讨应用磁共振扩散加权成像(DWI)对放射性肝损伤(RILI)的诊断价值。方法 2015年1月～2017年6月我院诊治的肝细胞癌患者90例,在接受放射治疗后,经超声引导下肝穿刺组织病理学检查证实为RILI患者47例。根据组织病理学检查,发现急性RILI 14例,亚急性期17例和慢性16例。常规行MRI检查。结果放射性肝损伤患者MRI上表现为与放射治疗区域一致的斑片状异常信号区,在T1WI上呈低信号,在T2WI上呈高信号,DWI序列呈稍高信号,增强扫描呈中等水平斑片样强化;急性期RILI表观弥散系数(ADC)值为(85.32±8.41)×10^(-6)mm^(-2)/s,显著低于亚急性期的(88.44±9.32)×10^(-6)mm^(-2)/s或慢性期的(101.28±10.01)×10^(-6)mm^(-2)/s,三组间差异有统计学意义(P<0.05)。结论及时行磁共振扩散加权成像检查能够协助诊断RILI的发生,其ADC值能够在一定程度上反映RILI病理学改变,结合照射剂量和患者病情可能提高临床治疗的安全性。

Objective The aim of this study was to investigate the diagnostic value of diffusion-weighted magnetic resonance imaging in patients with radiation-induced liver injury (RILI) with underlying hepatocelullar carcinoma (HCC). Methods 90 patients with histologically proven HCC were admitted to our hospital between January 2015 and June 2017,and RILI were confirmed by ultrasound-guided liver biopsies in 47 patients after radiotherapy. The pathological results showed the patients with acute RILI in 14,subacute in 17 and chronic in 16. All patients received MRI checked-up. Results The MRI manifestations in patients with RILI was a patchy abnormal signal area consistent with the radiation therapy,with low signal on T1WI,high signal on T2WI,slightly high signal on diffusion weighted imaging (DWI) sequence,and moderate enhancement on intensified scan;the apparent diffusion coefficient(ADC) value in patients with acute RILI was(85.32±8.41)×10^-6mm^-2/s,significantly lower than (88.44±9.32)×10^-6mm^-2/s in patients with subacute or (101.28±10.01)×10^-6mm^-2/s in patients with chronic RILI(P<0.05). Conclusion The application of diffusion-weighted MR imaging might help diagnose patients with RILI,which will benefit the patients with HCC undergoing radiotherapy.