| 摘要: |
| 目的：初步探讨磁共振(MR)扩散加权成像(DWI)在肝癌经导管动脉化疗栓塞术(TACE)后随访中应用的可行性和临床价值。方法：在1.5T MR机上，对16例肝癌行TACE术后患者分别进行DWI检查和MR常规平扫（T1WI和T2WI）。DWI检查取扩散敏感梯度因子(b值)为0及500 s/mm2，利用固定参数组合的自旋回波-平面回波(SE-EPI)序列，在各种成像序列上计数新发病灶数目，计算在DWI与T2WI上病灶与肝组织之间的对比噪声比(CNR)并予以比较；与DSA检查对照，定性评价DWI对肿瘤残留或复发活组织的检出能力。结果：DWI共显示肝内新发病灶46个，T2WI显示43个，T1WI显示38个。DWI及T2WI序列，新发病灶与肝组织之间的CNR差异有统计学意义(P=0.015 1)。行TACE术后病灶内部DWI信号较复杂，2例病灶为碘油沉积完整，DSA检查无肿瘤染色，DWI为均匀低信号；2例病灶为碘油沉积但出现局部缺损，DSA检查可见缺损区肿瘤染色，DWI图像上碘油沉积区表现为低信号，肿瘤染色区为高信号；12例病灶DSA检查可见无或稍许碘油沉积，造影见大量肿瘤染色，其内有无或轻微染色的缺血、坏死的肿瘤组织，DWI图像上肿瘤染色区域表现为高信号，缺血坏死区为低或较低信号。结论：DWI是一种敏感的检测肝癌TACE术后肝内新发病灶的无创性成像方法，可监测TACE术后病灶残留或复发活组织和碘油沉积情况，可以用于肝癌TACE术后的临床随访。 |
| 关键词: ]肝肿瘤；磁共振扩散加权成像；经导管动脉化疗栓塞术 随访 |
| DOI：10.3724/SP.J.1008.2007.00983 |
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| 基金项目: |
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| Clinical application of diffusion weighted MR imaging in follow-up of patients receiving transcatheter arterial chemoembolization for liver cancer |
| YUAN Zheng, XIAO Xiang-sheng, LIU Shi-yuan*, SUN Zhi-chao, DONG Sheng, DONG Wei-hua, JIA Ning-yang, YAN Bing |
| (Department of Radiology, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China) |
| Abstract: |
| Objective：To evaluate the feasibility of diffusion-weighted imaging (DWI) application in follow-up of patients receiving transcatheter arterial chemoembolization (TACE) for liver cancer and its clinical value. Methods: DWI and routine non-enhanced MRI were performed in 16 liver cancer patients after TACE with the same SE-EPI sequence (b=500 s/mm2 and 0) on 1.5 T MRI. The numbers of the new lesions detected by DWI, T1WI and T2WI were counted. Contrast noise ratios (CNR) between new lesions and liver tissues on DWI and T2WI were calculated and compared. The efficacy of SWI in diagnosis of residual tumor and recurrent cancer was qualitatively evaluated by comparing with DSA results. Results: DWI revealed 46 new lesions, T2WI revealed 43, and T1WI revealed 38. There was significant difference in CNR between new lesions and liver tissues on DWI and T2WI (P＜0.05). The signal intensities of liver cancer on DWI were complicated after TACE. Homogeneous accumulation of iodized oil was observed on DSA in 2 of 16 patients with liver cancer after TACE; there was no tumor staining on DSA at the corresponding site of homogeneous hypointensity on DWI. Partial defect of accumulation of iodized oil was noticed in 2 of 16 patients; there was tumor staining on DSA at the corresponding site of hyperintensity on DWI. No or faint accumulation of iodized oil was noticed in 12 patients; there was strong tumor staining at the corresponding site of hyperintensity on DWI; necrosis tumor had no or slight tumor staining on DSA at the corresponding site of hypointensity on DWI. Conclusion: Diffusion MRI is a sensitive method for detecting new lesions in patients with liver cancer after TACE, and can be used to monitor residual, recurrent cancer and iodized oil accumulation during follow-up of patients after TACE. |
| Key words: liver neoplasms diffusion weighted magnetic resonance imaging transcatheter arterial chemoembolization follow-up |
