磁共振评估大肝癌介入治疗后肿瘤活性的研究
MRI in evaluation of lesion activity after interventional therapy for large hepatocellular carcinoma
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摘要: 目的 探讨磁共振表观扩散系数(apparent diffusion coefficient,ADC)值定量分析大肝癌经肝动脉化疗栓塞术(transca-theter arterial chemoembolization,TACE)治疗疗效的价值。方法 回顾性分析2014年1月-2019年7月厦门长庚医院、林口长庚纪念医院及辽宁省健康产业集团抚矿总医院共40例距肝包膜缘最小距离≤1 cm大肝癌患者的影像资料。其中男性29例,女性11例,年龄25 ~ 80岁,中位年龄65岁。术前病灶平均直径约(6.8±1.5) cm。所有病例均行TACE 2次,每次TACE术前1周及术后1 ~ 3个月行MRI平扫+增强检查,每次TACE间隔时间为1 ~ 3个月。在MRI的ADC(b=800 s/mm2)选取并测量15个感兴趣区(ROI)ADC值。以DSA作金标准,评价TACE术前、术后病灶的位置、有无强化、碘油分布及病灶周围肝实质情况。并绘制ADC值受试者工作特征曲线,寻找ADC最佳临界值,估算其灵敏度、特异性。结果 40例患者共检出40个大肝癌病灶,获得541个ROI(因部分ROI无法测量准确ADC值,故舍弃)。第二次DSA共检测出95个ROI有肿瘤染色,为肿瘤残留或复发,为有活性,平均ADC值为(0.94±0.37)×10-3 mm2/s,446个ROI无肿瘤染色,为无活性,平均ADC值为(1.60±0.38)×10-3 mm2/s。ROC曲线分析表明,ADC值判断肿瘤治疗后活性区的敏感度、特异性分别为86.8%、87.4%,曲线下面积为0.934,截断值为1.14×10-3 mm2/s。术前、术后病灶包膜侧(ROI3)ADC值差异无统计学意义,但P值接近0.05(P=0.052);余病灶内ROI的ADC值术前、术后比较,差异均有统计学意义(P均<0.05);而病灶周围肝实质内ROI对应的ADC值术前术后比较差异无统计学意义(P>0.05)。结论 ADC值可相对准确定量评估大肝癌经TACE术后残存情况。Abstract: Objective To investigate the role of apparent diffusion coefficient (ADC) value in evaluating the therapeutic effect of transcatheter arterial chemoembolization (TACE) on large hepatocellular carcinoma with the minimum distance to the liver capsule≤1 cm. Methods The imaging data of 40 liver cancer patients with the minimum distance of the tumor to the liver capsule≤1 cm were retrospectively analyzed from January 2014 to July 2019 in Xiamen Chang Gung Hospital,Linkou Chang Gung Memorial Hospitaland Fukuang General Hospital of Liaoning Health Industry Group.All the patients underwent transcatheter arterial chemoembolization (TACE) twice.MRI plain scan and enhancement examination were performed 1 week before and after each TACE (with the interval of 1-3 months).ADC values of 15 regions of interest (ROI) were measured on MRI (b=800 s/mm2).Using DSA as the gold standard,the location,enhancement,lipiodol distribution and normal liver parenchyma around TACE were evaluated.The receiver operating characteristic curve (ROC) was drawn,and the cut-off value of ADC was identified,and its sensitivity and specificity were estimated. Results A total of 40 lesions were detected in 40 patients,and 541 ROIs were analyzed.A total of 95 active lesions (residual or recurrent tumor) were detected in the second DSA,and the corresponding ADC value was (0.94±0.37)×10-3 mm2/s,while the ADC value of 446 inactive lesions(no residual or recurrent tumor) was (1.60±0.38)×10-3 mm2/s.ROC curve analysis showed that the sensitivity and specificity of ADC was 86.8% and 87.4%,with cut-off value of 1.14×10-3 mm2/s,and the AUC was 0.934.There was no significant difference in the ADC value of ROI3 (the area of the lesion adjacent to glisson's capsule) before and after operation (P=0.052).The difference of ADC values of the ROIs in remaining lesions were significantly different before and after surgery (P<0.05).There was no significant difference in ADC values of the ROIs in peripheral hepatic parenchyma before and after operation (P>0.05). Conclusion ADC value can quantitatively evaluate the residule tumors of large hepatocellular carcinoma after TACE.
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