动态增强MRI及DWI评估肝恶性肿瘤微波消融术后短期预后的效果

Effect of Dynamic Contrast Enhanced MRI and DWI in Assessing Short-term Prognosis after Microwave Ablation of Malignant Hepatic Tumor

目的:探讨动态增强MRI(DCE-MRI)及扩散加权成像(DWI)对肝恶性肿瘤微波消融术(MWA)后短期预后的评估价值。方法:选取赣州市第五人民医院2019年1月-2021年1月收治的肝恶性肿瘤患者101例,患者均接受MWA治疗,记录患者术后1年的疾病进展情况,根据患者术后1年病情有无进展,将进展者纳入预后不良组,稳定者纳入预后良好组。采用DCE-MRI及DWI对病灶部位进行探查,记录各项定量参数,包括速率常数(K_(ep))、容量运转常数(K^(trans))、血管外/细胞外间隙容积比(Ve)、表观弥散系数(ADC)值。利用Pearson相关系数分析影像参数间的相关性,绘制接受者工作特征(ROC)曲线分析各参数并评估患者短期预后的曲线下面积(AUC)。结果:在101例患者中,术后1年的疾病累积进展率为21.78%。术前,预后良好组的K_(ep)低于预后不良组,ADC值高于预后不良组(P<0.05)。预后良好组术后1年的K_(ep)、K^(trans)均低于预后不良组,ADC值高于预后不良组(P<0.05)。相关性分析显示,肝恶性肿瘤患者的术前ADC值与K_(ep)呈负相关,术后ADC值与K_(ep)、K^(trans)均呈负相关(P<0.05)。术前K_(ep)、ADC值预测患者预后的AUC分别为0.764、0.836,二者联合预测的AUC为0.869。术后K_(ep)、K^(trans)、ADC值评估患者预后的AUC分别为0.830、0.846、0.810,三者联合预测的AUC为0.908。结论:DCE-MRI及DWI对肝恶性肿瘤患者短期预后具有较高评估价值,总体效果良好。

Objective:To investigate the value of dynamic contrast enhanced MRI(DCE-MRI)and diffusion weighted imaging(DWI)in the evaluation of the short-term prognosis of microwave ablation(MWA)for malignant hepatic tumor.Method:A total of 101 patients with malignant hepatic tumor who were admitted to the Ganzhou Fifth People’s Hospital from January 2019 to January 2021 were selected.All patients received MWA treatment,and the disease progress of patients in one year after surgery was recorded.According to the condition progress in one year after surgery,the patients who made progress were included in the poor prognosis group,and the patients who were stable were included in the good prognosis group.DCE-MRI and DWI were used to explore the lesion site,and various quantitative parameters were recorded,including rate constant(K_(ep)),volume transfer constant(K^(trans)),extravascular/extracellular space volume ratio(Ve),apparent diffusion coefficient(ADC)value.Pearson correlation coefficient was used to analyze the correlation between the image parameters,and receiver operating characteristic(ROC)curve was drawn to analyze each parameter and evaluate the area under the curve(AUC)of the short-term prognosis of the patients.Result:Among 101 patients,the cumulative disease progression rate was 21.78%one year after surgery.The K_(ep) in the good prognosis group before surgery was lower than that in the poor prognosis group,and the ADC value was higher than that in the poor prognosis group(P<0.05).The K_(ep) and K^(trans) in the good prognosis group one year after surgery were lower than those in the poor prognosis group,and the ADC value was higher than that in the poor prognosis group(P<0.05).Correlation analysis showed that preoperative ADC value of patients with malignant hepatic tumor had a negative correlation with K_(ep),while postoperative ADC value had a negatively correlated with K_(ep) and K^(trans)(P<0.05).Preoperative values of K_(ep) and ADC predicted AUC respectively was 0.764 and 0.836,and the AUC predicted by the combination of the two values was 0.869.The AUC of postoperative K_(ep),K^(trans),and ADC value to evaluate the patient’s prognosis respectively was 0.830,0.846,and 0.810,and the combined predicted AUC of the three was 0.908.Conclusion:DCE-MRI and DWI have high evaluation value for short-term prognosis of patients with malignant hepatic tumor,and the overall effect is good.