目的：观察晚期肝细胞肝癌（HCC）患者接受索拉非尼治疗后的影像学表现及表观扩散系数（apparent diffu‐sion coefficient ，ADC）值的变化规律。方法前瞻性纳入晚期HCC患者10例，口服索拉非尼前1周内、治疗后1～3周、6周及12周行上腹部MR扫描（含DWI序列）和CT扫描，测量肝内靶病灶ADC值，分析病灶的影像学特点及ADC值变化规律。结果影像学可评估病灶31个，包括14个有反应和17个无反应病灶。有反应病灶基线最大径及ADC值显著高于无反应病灶，有反应病灶治疗后ADC值变化率显著高于无反应病灶。无反应病灶 ADC值在治疗开始后6周内基本保持稳定，12周显著减低。治疗前后病灶大小未见显著性差异。结论包含DWI的MR及CT成像，有助于预测并早期监测 HCC患者索拉非尼治疗的疗效，实时评估治疗过程中的动态变化。%Objective To explore the findings on CT and MR scans in patients with advanced hepatocellular carcinoma (HCC) during molecular targeted therapy (Sorafenib) ,with a focus on the change of apparent diffusion coefficient (ADC) values obtained from MR diffusion‐weighted imaging (DWI) .Methods Ten patients with advanced HCC were included . Upper abdominal MR‐DWI scans (b=500 ,800 s/mm2 ) were performed within 1 week prior to ,1~3 weeks ,6 weeks and 12 weeks after the start of molecular targeted therapy .ADC values of hepatic lesions were measured .Results Thirty‐one HCC lesions ,which underwent molecular targeted therapy ,could be assessed by imaging modality ,14 were responsive and the other 17 lesions fell into the nonresponsive group .The largest diameters and the ADC values of the responsive le‐sions at the baseline were significantly higher than those of the non‐responsive group .The rate of change of ADC values after the start of treatment in responsive group was significantly higher than that in non‐responsive group .And the ADC values remained stable in non‐responsive lesions within 6 weeks after the start of treatment .No significant change of the largest diameter could be observed at the end of follow‐up ,in both responsive and non‐responsive groups .Conclusion MR including DWI and CT scans can help to predict and monitor the efficacy of molecular targeted therapy in HCC patients and give real‐time evaluation of dynamic changes in the course of treatment .
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