摘要
目的研究磁共振弥散加权成像(MR-DWI)在肝脏恶性肿瘤疗效评估中的应用。方法前瞻性纳入67例行索拉非尼治疗的肝细胞性肝癌(HCC)患者,分别于治疗前1周,治疗后第1~3周、6周和12周进行MR扫描,分析其影像学特征和ADC值变化。结果 67例患者共发现194个可评估癌灶,大小不等,MR平扫期为等、低信号,T2WI为等、高信号,增强扫描后符合肝癌"快进快出"表现,MR-DWI扫描为高信号,ADC图呈低信号,较大癌灶存在坏死区域,面积≤10%;治疗后,有反应组癌灶112个,无反应组癌灶82个,有反应癌灶MR-DWI图像从高信号逐渐下降,ADC图信号逐渐上升,初期T1W1、T2W1信号升高,后期未见信号强度改变;无反应癌灶DWI、T1W1、T2W1信号未见明显改变,部分癌灶T1W1信号较高;治疗后有反应组癌灶ADC值在b=500 s·mm^(-2)时逐渐升高(P<0.05),在b=800 s·mm^(-2)时为先升高(P<0.05)、后平稳;无反应组在b=500 s·mm^(-2)时ADC值无显著变化(P>0.05),在b=800 s·mm^(-2)时治疗后6周前变化不显著(P>0.05),治疗后12周显著降低(P<0.05);两组组间ADC值的差异有统计学意义(P<0.05)。结论 MR-DWI可实时评估HCC患者分子靶向治疗疗效,早期预测肿瘤复发情况,采用b=500 s·mm^(-2) ADC值在疗效预测方面敏感性较高,采用b=800 s·mm^(-2) ADC值在早期监测复发、变化方面敏感性较高。
Objective To study the application of magnetic resonance diffusion weighted imaging （MR-DWI） in evaluating the curative effect for treatment of patients with malignant liver tumor. Methods 67 patients with hepatocellular carcinoma （HCC） treated with sorafenib were prospectively collected. MR scanning was performed at 1 week before treatment, at 1~3 weeks, 6 weeks and 12 weeks after treatment for patients. The imaging findings and changes of ADC value were analyzed. Results There were a total of 194 assessable neoplastic foci in 67 patients, which ranged in size, MR plain scan showed equal and low signal, and the T2WI showed equal and high signal. After enhanced scan, it accorded with liver cancer fast-in fast-out signs. MR-DWI scanning showed high signal and ADC showed low signal. There was necrosis area in relatively larger neoplastci foci, and the area was ≤ 10%. After treatment, there were 112 neoplastci foci with response and 82 without. The MR-DWI images of neoplastci foci with response showed gradually decreasing high signal while ADC showed gradu- ally increasing signal. Signals on TIW1 and T2W1 increased in the early stage and there was no change in late stage. There were no obvious changes of signals on DWI, T1W1 and T2W1 of neoplastci foci without response. Some neoplastci foci showed relatively higher signal on T1WI. After treatment, ADC values of neoplastci foci with response increased gradually at b=500 s·mm^-2, while it increased firstly and then became stable at b=800 s·mm^-2（P〈0.05）. There were no significant changes of ADC value in the non-response group at b=500 s·mm^-2 （P〉 0.05）, and at b=800 s·mm^-2 in 6 weeks after treatment （P〉 0.05）. At 12 weeks after treatment, the values significantly decreased （P〈 0.05）. There were significant differences in ADC values between the two groups （P 〈 0.05）. Conclusion MR-DWI can be used to evaluate the effect of molecular targeted therapy in patients with HCC in real time and predict recurrence of tumors. The sensitivity of b=500 s·mm^-2 ADC value is high in predicting the curative effect while the sensitivity of b=800 s·mm^-2 ADC value is high in early monitoring recurrence and changes.
出处
《肿瘤药学》
CAS
2017年第4期483-487,共5页
Anti-Tumor Pharmacy
基金
常德市科技计划一般项目(2013SK09)
关键词
肝细胞肝癌
MR-DWI
疗效评估
Hepatocellular carcinoma
MR-DWI
Evaluation of the curative effect
