Marugami Nagaaki, Tanaka Toshihiro, Kitano Satoru, Hirohashi Shinji, Nishiofuku Hideyuki, Takahashi Aki, Sakaguchi Hiroshi, Matsuoka Masaki, Otsuji Toshio, Takahama Junko, Higashiura Wataru, Kichikawa Kimihiko
Department of Radiology, Nara Medical University, 840 Shijo-cho, Kashihara, 634-8522, Japan.
Cardiovasc Intervent Radiol. 2009 Jul;32(4):638-46. doi: 10.1007/s00270-009-9532-8. Epub 2009 Feb 24.
The purpose of this study was to investigate whether diffusion-weighted magnetic resonance imaging (DWI) is useful for early detection of the response of hepatic colorectal metastases to hepatic arterial infusion chemotherapy (HAIC) with 5-fluorouracil (5-FU). The subjects were 12 patients with hepatic colorectal metastases. The indwelling catheter for HAIC was placed in the hepatic artery, and 1000 mg/m(2) 5-FU was given repeatedly once a week. DWI was performed before and 9 days after HAIC. The minimum and mean apparent diffusion coefficient (ADC) values (minADC and meanADC) were measured. The relative change in ADC values (%ADC) and the relative change in tumor size on follow-up CT after 3 months (reduction ratio) were determined. Liver metastases were divided into two groups, responder and nonresponder. The correlation between %ADC and reduction ratio was determined, and %ADC was compared between the two groups. Eleven patients successfully completed HAIC over the 3-month period; 48 metastatic lesions were evaluated. Positive correlations were observed for relative change between %minADC and reduction ratio (r = 0.709) and between %meanADC and reduction ratio (r = 0.536). Both %minADC and %meanADC were significantly greater in the responder group than in the nonresponder group. With the threshold determined as < 3.5%, the receiver-operating curve analysis showed higher sensitivity and specificity values for %minADC (100% and 92.6%, respectively) than for %meanADC (66.7% and 74.1%, respectively). In conclusion, the relative change in minimum ADC values on DWI may be useful for early detection of the response of liver metastases to HAIC with 5-FU.
本研究的目的是调查扩散加权磁共振成像（DWI）是否有助于早期检测肝结肠转移瘤对含5-氟尿嘧啶（5-FU）的肝动脉灌注化疗（HAIC）的反应。研究对象为12例肝结肠转移瘤患者。将用于HAIC的留置导管置于肝动脉中，每周重复给予1000mg/m²的5-FU。在HAIC前和HAIC后9天进行DWI检查。测量最小和平均表观扩散系数（ADC）值（minADC和meanADC）。确定ADC值的相对变化（%ADC）和3个月后随访CT上肿瘤大小的相对变化（缩小率）。肝转移瘤分为反应者和无反应者两组。确定%ADC与缩小率之间的相关性，并比较两组之间的%ADC。11例患者在3个月内成功完成HAIC；共评估了48个转移灶。观察到%minADC与缩小率之间（r = 0.709）以及%meanADC与缩小率之间（r = 0.536）存在正相关。反应者组的%minADC和%meanADC均显著高于无反应者组。将阈值确定为<3.5%时，受试者操作特征曲线分析显示，%minADC的敏感性和特异性值（分别为100%和92.6%）高于%meanADC（分别为66.7%和74.1%）。总之，DWI上最小ADC值的相对变化可能有助于早期检测肝转移瘤对含5-FU的HAIC的反应。
