Rhee Thomas K, Naik Neel K, Deng Jie, Atassi Bassel, Mulcahy Mary F, Kulik Laura M, Ryu Robert K, Miller Frank H, Larson Andrew C, Salem Riad, Omary Reed A
Department of Radiology, Northwestern University Feinberg School of Medicine, 737 North Michigan Avenue, Suite 1600, Chicago, IL 60611, USA.
J Vasc Interv Radiol. 2008 Aug;19(8):1180-6. doi: 10.1016/j.jvir.2008.05.002. Epub 2008 Jun 25.
Anatomic magnetic resonance (MR) imaging assessment of hepatocellular carcinoma (HCC) response to yttrium-90 ((90)Y) radioembolization may require 3 months before therapeutic effectiveness can be determined. The relationship between anatomic MR and diffusion-weighted imaging (DWI) changes after (90)Y therapy is unclear. The present study tested the hypothesis that apparent diffusion coefficient (ADC) values on DWI at 1 month precede anatomic tumor size change at 3 months after (90)Y radioembolization.
In this prospective study, 20 patients with HCC (16 men) enrolled between April 2005 and July 2006 underwent lobar (90)Y therapy with mean doses of 141 Gy (right lobe) and 98 Gy (left lobe). Anatomic 1.5-T MR imaging (gadolinium-enhanced T1-weighted gradient-recalled echo) and DWI (single-shot spin-echo echo-planar imaging; b value of 0, 500 sec/mm(2)) were performed at baseline (0-3 weeks before (90)Y therapy) and at 1 and 3 months after (90)Y therapy. Tumor size and ADC values were measured and compared, and the percentage change in ADC was compared to the change in tumor size (minimum >5% change in size), with use of a paired t test (alpha = .05).
Yttrium-90 therapy was successfully delivered in all patients. The mean baseline ADC of 1.64 x 10(-3) mm(2)/sec +/- 0.30 significantly increased to 1.81 x 10(-3) mm(2)/sec +/- 0.37 at 1 month (P = .02), and to 1.82 x 10(-3) mm(2)/sec +/- 0.23 at 3 months (P = .02). The mean baseline tumor size of 83.0 cm(2) +/- 63.7 did not change statistically at 1 month (84.1 cm(2) +/- 62.1; P = .75) or 3 months (74.0 cm(2) +/- 57.0; P = .10). The overall mean ADC percentage change at 1 month of 10.5% +/- 23.1% preceded an overall mean tumor size percentage change at 3 months of -18.5% +/- 31.5% (P = .03).
HCC tumor response assessed with DWI at 1 month preceded anatomic size changes at 3 months after (90)Y therapy. DWI may assist in early determination of the response or failure of (90)Y therapy for HCC.
肝细胞癌（HCC）对钇-90（90Y）放射性栓塞治疗反应的解剖磁共振（MR）成像评估可能需要3个月才能确定治疗效果。90Y治疗后解剖MR与扩散加权成像（DWI）变化之间的关系尚不清楚。本研究检验了以下假设：90Y放射性栓塞治疗后1个月时DWI上的表观扩散系数（ADC）值先于3个月时的肿瘤解剖大小变化。
在这项前瞻性研究中，20例HCC患者（16例男性）于2005年4月至2006年7月入组，接受叶内90Y治疗，右叶平均剂量为141 Gy，左叶平均剂量为98 Gy。在基线时（90Y治疗前0 - 3周）以及90Y治疗后1个月和3个月进行1.5-T解剖MR成像（钆增强T1加权梯度回波）和DWI（单次激发自旋回波平面回波成像；b值为0、500 sec/mm2）。测量并比较肿瘤大小和ADC值，并使用配对t检验（α = 0.05）将ADC的百分比变化与肿瘤大小变化（大小变化最小值>5%）进行比较。
所有患者均成功接受了90Y治疗。平均基线ADC值1.64×10-3 mm2/sec±0.30在1个月时显著增加至1.81×10-3 mm2/sec±0.37（P = 0.02），在3个月时增加至1.82×10-3 mm2/sec±0.23（P = 0.02）。平均基线肿瘤大小83.0 cm2±63.7在1个月时（84.1 cm2±62.1；P = 0.75）或3个月时（74.0 cm2±57.0；P = 0.10）无统计学变化。1个月时ADC总体平均百分比变化10.5%±23.1%先于3个月时肿瘤总体平均大小百分比变化-18.5%±31.5%（P = 0.03）。
90Y治疗后1个月时用DWI评估的HCC肿瘤反应先于3个月时的解剖大小变化。DWI可能有助于早期确定90Y治疗HCC的反应或治疗失败情况。
