肝癌經導管動脈灌注化療栓塞術療效的MR 擴散加權成像動態研究
尚全良 肖恩華 賀忠 譚利華 司徒衛軍 白末了 袁術文 杜萬平
【摘要】 目的 探討MR 擴散加權成像( DWI) 在原發性肝癌經導管動脈化療栓塞術( TACE) 療
效動態評價中的作用。方法 在1. 5 T GE Signa Twin speed MR 機上, 取擴散敏感梯度因子( b 值) 為0
及800 s /mm2 , 利用固定參數組合的自旋回波-平面回波( SE-EPI) 序列對首次行TACE 治療的25 例肝
癌腫塊分別于術前24 ～48 h、術后36 ～48 h、術后7 ～10 d、術后30 ～38 d 內各進行1 次DWI, 對每次
的圖像進行后處理, 計算出每例肝癌每個時點的表觀擴散系數( ADC 值) , 對各個時點的ADC 值進行
對比研究, 并結合第1 次TACE 術后與第2 次TACE 術前腫瘤的血管造影染色及碘油沉積的改變判
斷腫瘤的復發情況。結果 術前24 ～48 h、術后36 ～48 h、術后7 ～10 d、術后30 ～38 d 組的ADC 值
分別為( 1. 376 ±0. 012)× 10 - 3mm2 / s、( 1. 598 ±0. 012)× 10 - 3 mm2 / s、( 1. 723 ±0. 012)× 10 - 3 mm2 / s、
( 1. 684 ±0. 012)× 10 - 3mm2 / s。術后各組肝癌組織的ADC 值較術前明顯升高( P < 0. 05) ; 術后7 ～
10 d、術后30 ～38 d 組的ADC 值較術后36 ～48 h 組明顯升高( P < 0. 05) ; 術后30 ～38 d 的ADC 值較
術后7 ～10 d 組明顯降低( P < 0. 05) 。將第1 次TACE 術后與第2 次TACE 術前的造影片及碘油沉積
片對比見術后30 ～38 d ADC 值下降的肝癌病例都有不同程度的復發, ADC 值下降明顯的復發也最
為明顯。結論 利用MR DWI 技術對肝癌組織的ADC 值進行動態觀察, 可以評價肝癌TACE 術后癌
組織的壞死、復發情況。
【關鍵詞】 癌, 肝細胞; 磁共振成像; 擴散; 化療栓塞, 治療性
Dynamic study of efficacy of tr ansca thet er a rter ial chemoembolization ( TACE) of pr imar y liver
car cinoma with the MR diffusion-weight ed ima ging ( DWI ) SHANG Quan-liang, XIAO En-hua, HE
Zhong, TAN Li-hua, SITU Wei-jun, BAI Mo-liao, YUAN Shu-wen, DU Wan-ping. Depa rtment of
Radiology, the Second Xiangya Hospital, Central South University, Changsha 410011, China
Corresponding author: XIAO En-hua , Email: cjr. xiaoenhua@vip. 163. com
【Abst ract】 Objective To dynamically evaluate the efficacy of treatment of primary liver carcinoma
( PLC) by transcatheter arterial chemoembolization( TACE) with the MR diffusion-weighted imaging( DWI) .
Methods DWI and the measurement of mean apparent diffusion coeffecient( ADC) value were performed in
25 masses of PLC with the same SE-EPI sequence ( b = 800 s /mm2 and 0) at 1. 5 T MRI within the 24—
48 hours before TACE ( group A) and 36—48 hours, 7—10 days, 30—38 days after TACE ( group B, group
C, group D) . The differences of the mean ADC values of PLC between groups were analyzed. Results The
mean ADC values of the three groups after TACE the mean ADC value of group B: ( 1. 598 ±0. 012 ) ×
10 - 3mm2 / s, the mean ADC value of group C: ( 1. 723 ±0. 012 )× 10 - 3 mm2 / s, the mean ADC value of
group D: ( 1. 684 ±0. 012)× 10 - 3 mm2 / s were significantly greater than that of the group before TACE the
mean ADC value of group A: ( 1. 376 ±0. 012) × 10 - 3 mm2 / s ( P < 0. 05) . The mean ADC values of the
group C and the group D were significantly greater than that of the group B ( P < 0. 05 ) . The mean ADC
values of the group D was lower than that of the group C ( P < 0. 05 ) . Through contrasting the digital
subtraction angiography ( DSA) imaging of the second TACE with that of the first TACE, we found that every
PLC whose mean ADC value after 30—38 days of the TACE was lower than that after 7—10 days of the
TACE could be found the recurrence, especially in those PLC whose mean ADC values were decreased
greatly. Conclusion With the measurement of ADC value of the different time of the PLC we could
excellently evaluate the necrosis and the recurrence of the PLC after the operation of the TACE.
【Key words 】 Carcinoma, hepatocellular; Magnetic resonance imaging; Diffusion;