磁共振扩散加权成像对肝癌TACE术后的影像分析及指导价值

摘要

Objective Our aim is to evaluate the clinical value of image assessment and guidance of MR diffusion - weighted imaging (DWI) on liver transcatheter arterial infusion chemotherapy embolization (TACE). Methods 30 cases of giant hepatic carcinoma patients were collected. The patients underwent the DWI scan 24 -48 hours pre - operation and 24-48 hours, 14 - 16 days and 30 -32 days post -operation (before the second TACE). The machine include Siemens Espree 1. ST magnetic resonance imaging machine with b values of 300, 600 and 800 s/mm2. The average ADC values and the MRI signal value of tumor in different time were compared. Results All the ADC values of post - operation hepatocellular carcinoma were significantly higher than that of pre - operation ( P < 0.05), the ADC value arrived the peak in 14 -16 days post - operation because of the liquefaction and necrosis of tumor cells. The ADC values decreased at the 30 - 32 days post - operation. Compared with the second TACE, the tumor recurred at different degrees. 18 lesions were found in the second TACE, the diagnosis consistent rate of MRI with enhance scan was 85.7% .that of DWI was 94.7%. By analyzing the images of different b,there was the clearest images and highest sensitivity when b was 600 s/mm2. Conclusion DWI is with high sensitivity and specificity for residue or recurrence lesions of liver cancer patients after TACE, and it is an effective method.%目的 探讨磁共振(MRI)扩散加权成像(DWI)对肝癌经导管动脉化疗栓塞术(TACE)术后疗效的影像评估及指导价值.方法搜集30例行TACE治疗的巨块型肝癌患者,于术前24 -48 h、术后24 ～48 h、14～16 d及30～32 d(二次TACE术前)行MRI平扫、增强及DWI扫描,b值选300、600及800 s/mm2,比较不同时间段瘤区组织的平均表现扩散示数(ADC)值的变化并观察同期肿瘤MRI信号变化.结果 术后各组肝癌组织的ADC值较术前明显升高(P＜0.05),术后14～16 d病变ADC值最高,是肿瘤细胞液化、坏死高峰期.术后30～32 d ADC值下降,与二次TACE对比,肿瘤细胞都有不同程度的复发.二次TACE发现病变18处,MRI平扫及增强诊断相符率85.7%.DWI诊断相符率94.7%.不同b值图像分析,b值选600 s/mm2时,图像较清晰,病变敏感性高.结论 核磁功能成像DWI对肝癌TACE术后肿瘤细胞残存、复发具有高敏感性、特异性,可有效评估肝癌TACE术后疗效,指导临床治疗方案.