Liapi Eleni, Geschwind Jean-Francois, Vossen Josephina A, Buijs Manon, Georgiades Christos S, Bluemke David A, Kamel Ihab R
Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, 601 N Caroline St., Rm. 100, Baltimore, MD 21287, USA.
AJR Am J Roentgenol. 2008 Jan;190(1):67-73. doi: 10.2214/ajr.07.2550.
The purpose of this study was to evaluate contrast-enhanced and diffusion-weighted MRI changes in neuroendocrine tumors treated with transcatheter arterial chemoembolization (TACE).
Sixty-six targeted lesions in 26 patients (18 men, eight women; mean age, 57 years) with hepatic metastasis of neuroendocrine tumors treated with TACE were retrospectively analyzed. MRI studies were performed before and after TACE. Imaging features included tumor size, percentage of enhancement in the arterial and portal venous phases, and diffusion-weighted imaging apparent diffusion coefficients (ADCs) of the tumor, liver, and spleen. Tumor response to treatment was recorded according to World Health Organization criteria and Response Evaluation Criteria in Solid Tumors. Liver function tests were performed, and clinical performance was assessed before and after treatment. Statistical analysis included paired Student's t tests and Kaplan-Meier survival curves.
Mean tumor size and percentage enhancement in the arterial and portal venous phases decreased significantly after treatment (p < 0.0001). The tumor ADC increased from 1.51 x 10(-3) mm2/s before treatment to 1.79 x 10(-3) mm2/s after treatment (p < 0.0001), but the ADCs for the liver and spleen remained unchanged. Despite the change in tumor size, no patient in this cohort achieved complete response according to World Health Organization criteria and Response Evaluation Criteria in Solid Tumors. Partial response was achieved in only 27% and 23% of the patients according to the respective criteria. Results of liver function tests and performance status also remained unchanged. The mean survival period for all patients was 78 months.
Contrast-enhanced and diffusion-weighted imaging showed significant changes after TACE of neuroendocrine tumors and can be used to assess response of targeted tumors.
本研究旨在评估经动脉化疗栓塞术（TACE）治疗的神经内分泌肿瘤的对比增强磁共振成像（MRI）及扩散加权成像（DWI）变化。
回顾性分析26例（18例男性，8例女性；平均年龄57岁）接受TACE治疗的神经内分泌肿瘤肝转移患者的66个靶向病变。在TACE治疗前后均进行了MRI检查。成像特征包括肿瘤大小、动脉期和门静脉期强化百分比，以及肿瘤、肝脏和脾脏的扩散加权成像表观扩散系数（ADC）。根据世界卫生组织标准和实体瘤疗效评价标准记录肿瘤对治疗的反应。进行肝功能检查，并在治疗前后评估临床表现。统计分析包括配对t检验和Kaplan-Meier生存曲线。
治疗后肿瘤平均大小及动脉期和门静脉期强化百分比均显著降低（p < 0.0001）。肿瘤ADC从治疗前的1.51×10⁻³mm²/s增加至治疗后的1.79×10⁻³mm²/s（p < 0.0001），但肝脏和脾脏的ADC保持不变。尽管肿瘤大小发生了变化，但根据世界卫生组织标准和实体瘤疗效评价标准，该队列中无患者达到完全缓解。根据各自标准，仅27%和23%的患者达到部分缓解。肝功能检查结果和性能状态也保持不变。所有患者的平均生存期为78个月。
对比增强MRI和DWI显示神经内分泌肿瘤TACE治疗后有显著变化，可用于评估靶向肿瘤的反应。
