Department of Radiology, Nanjing Jinling Hospital, Clinical School of Medical College, Nanjing University, 305 East Zhong Shan Road, Nanjing, Jiangsu Province 210002, PR China.
J Vasc Interv Radiol. 2011 Aug;22(8):1166-73. doi: 10.1016/j.jvir.2011.04.010. Epub 2011 Jun 23.
To evaluate the value of phosphorus-31 ((31)P) magnetic resonance (MR) spectroscopy in early monitoring and predicting the response of hepatocellular carcinoma (HCC) after chemoembolization.
The authors evaluated 17 HCC target tumors with (31)P MR spectroscopy before and after chemoembolization. Alterations of phosphorus metabolism were analyzed by the MR spectroscopy analysis package (SAGE 7.0; GE Medical Systems, Milwaukee, Wisconsin). Ratios of the peak areas of phosphomonoesters (PME), phosphodiesters (PDE), and inorganic phosphate (Pi) to the peak area of nucleoside triphosphates (NTP) or the total phosphorus content (TPC) were measured. The changes in these ratios after chemoembolization were calculated from baseline (before chemoembolization). The therapy effect was assessed by computed tomography (CT) or MR imaging 4 weeks after chemoembolization. The ability of phosphorus metabolism in monitoring therapy effect was evaluated by using receiver operating characteristic analysis.
Decreases in the PDE/NTP ratio (Wilcoxon signed rank test, P = .024) and the PDE/TPC ratio (Wilcoxon signed rank test, P = .011) that occurred after treatment were the most remarkable changes secondary to chemoembolization. Of the 17 lesions evaluated quantitatively, at the follow-up examination done 4 weeks after chemoembolization, 12 lesions were responsive to chemoembolization, whereas 5 were not. In the responsive group, the PDE/TPC ratio (median 24.15% vs 13.15%; P = .008) was significantly decreased after chemoembolization, whereas the NTP/TPC ratio (median 37.35% vs 49.9%; P = .024) was significantly increased. In the nonresponsive group, phosphorus metabolism had no significant changes after treatment. Results from the receiver operating curve analysis showed that the threshold percentage change of the PDE/NTP (%PDE/NTP) value was -1.25% with 91.7% sensitivity and 100% specificity for identifying tumor response to chemoembolization, and the threshold percentage change of the NTP/TPC (%NTP/NTP) value was 15.3% with 75% sensitivity and 100% specificity.
Phosphorus-31 MR spectroscopy is a promising technique for the noninvasive assessment of HCC response to chemoembolization. Future studies are necessary to confirm these preliminary results.
评估磷-31（31P）磁共振（MR）光谱在肝癌（HCC）经化疗栓塞治疗后早期监测和预测疗效中的价值。
本研究对 17 个 HCC 靶病灶进行了化疗栓塞前后的 31P MR 光谱评估。通过 MR 光谱分析软件包（SAGE 7.0；GE Medical Systems，Milwaukee，威斯康星州）分析磷代谢的变化。测量磷酸单酯（PME）、磷酸二酯（PDE）和无机磷（Pi）与核苷三磷酸（NTP）峰面积比或总磷含量（TPC）的峰面积比。根据基线（化疗栓塞前）计算化疗栓塞后这些比值的变化。4 周后通过 CT 或 MR 成像评估治疗效果。采用受试者工作特征（ROC）分析评估磷代谢监测治疗效果的能力。
化疗栓塞后最显著的变化是 PDE/NTP 比值（Wilcoxon 符号秩检验，P =.024）和 PDE/TPC 比值（Wilcoxon 符号秩检验，P =.011）降低。在定量评估的 17 个病灶中，在化疗栓塞后 4 周的随访检查中，12 个病灶对化疗栓塞有反应，5 个病灶无反应。在有反应的组中，化疗栓塞后 PDE/TPC 比值（中位数 24.15%比 13.15%；P =.008）显著降低，而 NTP/TPC 比值（中位数 37.35%比 49.9%；P =.024）显著升高。在无反应的组中，治疗后磷代谢无明显变化。ROC 分析结果显示，PDE/NTP 值的阈值百分比变化（%PDE/NTP）为-1.25%，对化疗栓塞治疗后肿瘤反应的灵敏度为 91.7%，特异性为 100%；NTP/TPC 值的阈值百分比变化（%NTP/NTP）为 15.3%，灵敏度为 75%，特异性为 100%。
磷-31 MR 光谱是一种很有前途的技术，可用于非侵入性评估 HCC 对化疗栓塞的反应。需要进一步的研究来证实这些初步结果。
