【摘要】 目的探讨基于复合灵敏度编码的体素不相干运动（MUSE-IVIM）与非对比增强T₁ mapping定量参数对肝癌经导管动脉化疗栓塞（TACE）疗效的预测价值。方法选取原发性肝癌患者64例，TACE治疗后随访3～6个月，根据改良实体瘤疗效评估标准分为良好反应组28例、较差反应组36例。TACE治疗前1～2周行MUSE-IVIM及T₁ mapping扫描，获取MUSE-IVIM定量参数标准表观扩散系数（standard ADC）值、慢速表观扩散系数（slow ADC）值、快速表观扩散系数（fast ADC）值以及灌注分数（f）值、水分子扩散分布指数（DDC）值和扩散异质性指数（α）值，T₁ mapping定量参数初始瘤内与瘤周纵向弛豫时间（T₁）值。比较两组MUSE-IVIM及T₁ mapping定量参数，采用多因素Logistic回归模型筛选与肝癌TACE疗效相关的危险因素，预测效能评估采用受试者工作特征（ROC）曲线。结果两组MUSE-IVIM定量参数standard ADC值和slow ADC值比较差异均有统计学意义（P均<0.05），而MUSE-IVIM定量参数fast ADC值、f值、DDC值、α值及初始瘤内T₁值、初始瘤周T₁值比较差异均无统计学意义（P均>0.05）。多因素Logistic回归分析发现standard ADC值、slow ADC值均为预测肝癌TACE疗效的独立危险因素（P均<0.05）。ROC曲线分析显示standard ADC值、slow ADC值及二者联合预测肝癌TACE疗效的曲线下面积（AUC）分别为0.85、0.86、0.89，虽然显示standard ADC值、slow ADC值联合预测肝癌TACE疗效的AUC高于二者单独，但其比较差异无统计学意义（P均>0.05）。结论MUSE-IVIM定量参数standard ADC值和slow ADC值对肝癌TACE疗效具有较好的预测价值，而非对比增强T₁ mapping技术不能很好地预测肝癌TACE疗效。更多还原

【Abstract】 Objective To explore the predictive value of quantitative parameters by multishot diffusion imaging-base multiplexed sensitivity encoding intravoxel incoherent motion （MUSE-IVIM） and non-contrast-enhanced T₁ mapping-enhanced in transcatheter arterial chemoembolization （TACE） for hepatocellular carcinoma （HCC）.Methods Sixty-four patients with primary liver cancer were selected and followed up for 3-6 months after TACE treatment.According to the modified evaluation criteria for solid tumor efficacy,they were divided into a good response group （28 cases） and a poor response group （36 cases）.MUSE-IVIM and T₁ mapping scans were performed 1 to 2 weeks before TACE treatment.The MUSE-IVIM quantitative parameters in terms of standard apparent diffusion coefficient （standard ADC）,slow apparent diffusion coefficient （slow ADC）,fast apparent diffusion coefficient （fast ADC）,perfusion fraction （f）,water molecular diffusion distribution index （DDC）,diffusion heterogeneity index （α）,and T₁ mapping quantitative parameters initial intra tumoral and peritumoral longitudinal relaxation time （T₁） values were obtained.Quantitative parameters of MUSE-IVIM and T₁ mapping were compared between the two groups.Multivariate Logistic regression model was used to screen the risk factors associated with TACE treatment,and the predictive efficacy was evaluated by receiver operating characteristic （ROC） curve.Results There were significant differences in standard ADC and slow ADC values of MUSE-IVIM quantitative parameters between the two groups （P<0.05）.There were no significant differences in MUSE-IVIM quantitative parameters such as fast ADC value,f value,DDC value,α value,initial intratumoral T₁ value and initial periatumoral T₁ value （P>0.05）.Multivariate Logistic regression analysis showed that standard ADC value and slow ADC value were independent risk factors for predicting TACE treatment effect of liver cancer （P<0.05）.ROC curve analysis showed that the AUC of standard ADC value,slow ADC value and their combination in predicting TACE treatment effect of liver cancer were 0.85,0.86 and 0.89,respectively.Although the combination of standard ADC value and slow ADC value predicted the AUC of TACE treatment effect of liver cancer,the difference was not statistically significant （P>0.05）.Conclusion MUSE-IVIM quantitative parameters standard ADC value and slow ADC value have good predictive value for TACE treatment of liver cancer,but non-contrast enhanced T₁ mapping technology can not predict the TACE treatment effect of liver cancer.更多还原