磁共振弥散加权成像在评价肝癌化疗栓塞后反应中的作用。

Role of magnetic resonance diffusion-weighted imaging in evaluating response after chemoembolization of hepatocellular carcinoma.

机构信息

Department of Radiology, Affiliated Changzheng Hospital, The Second Military Medical University, 415 Feng Yang Road, Shanghai 200003, PR China.

出版信息

Eur J Radiol. 2010 Jul;75(1):e9-14. doi: 10.1016/j.ejrad.2009.05.040. Epub 2009 Jun 18.

DOI:10.1016/j.ejrad.2009.05.040

PMID:19540083

Abstract

OBJECTIVE

To investigate the value of hepatocellular carcinoma pretreatment apparent diffusion coefficients (ADCs) and its ADCs changes after treatment in predicting and early monitoring the response after chemoembolization.

MATERIALS AND METHODS

Twenty-five responding and nine nonresponding hepatocellular carcinoma lesions were prospectively evaluated with magnetic resonance diffusion-weighted imaging in 24 h before and in 48 h after chemoembolization. Quantitative ADC maps were calculated with images with b values of 0 and 500 s/mm(2).

RESULTS

Nonresponding lesions had a significantly higher pretreatment mean ADC than did responding lesions (1.726+/-0.323 x 10(-3) mm(2)/s vs.1.294+/-0.18510(-3) mm(2)/s, P< or =0.001). The results of receiver operator characteristic (ROC) analysis for identification of nonresponding lesions showed that threshold ADC value of 1.618 x 10(-3) mm(2)/s had 96.0% sensitivity and 77.8% specificity. After transarterial chemoembolization, responding lesions had a significant increase in %ADC values than did nonresponding lesions (32.63% vs. 5.24%, P=0.025). The results of ROC analysis for identification of responding lesions showed that threshold %ADC value of 16.21% had 72% sensitivity and 100% specificity. No significant change was observed in normal liver parenchyma (P=0.862) and spleen (P=0.052).

CONCLUSION

High pretreatment mean ADC value of hepatocellular carcinoma was predictive of poor response to chemoembolization. A significant increase in %ADC value was observed in lesions that responded to chemoembolization.

摘要

目的

探讨肝细胞癌（HCC）治疗前表观扩散系数（ADC）及其治疗后 ADC 变化在预测和早期监测化疗栓塞治疗反应中的价值。

材料与方法

前瞻性评估 24 例 HCC 患者共 25 个化疗栓塞治疗有效病灶和 9 个化疗栓塞治疗无效病灶，分别于化疗栓塞治疗前 24 h 及治疗后 48 h 行磁共振扩散加权成像，计算 b 值为 0 和 500 s/mm2 时的 ADC 值图。

结果

化疗栓塞治疗无效病灶的治疗前平均 ADC 值明显高于治疗有效的病灶（1.726±0.323×10-3mm2/s比 1.294±0.185×10-3mm2/s，P≤0.001）。受试者工作特征（ROC）曲线分析鉴别化疗栓塞治疗无效病灶的最佳 ADC 值阈值为 1.618×10-3mm2/s，其敏感度为 96.0%，特异度为 77.8%。化疗栓塞治疗后，治疗有效的病灶的%ADC 值明显高于治疗无效的病灶（32.63%比 5.24%，P=0.025）。ROC 曲线分析鉴别化疗栓塞治疗有效的最佳%ADC 值阈值为 16.21%，其敏感度为 72.0%，特异度为 100.0%。正常肝实质（P=0.862）和脾脏（P=0.052）ADC 值在化疗栓塞前后均无明显变化。