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钆塞酸二钠增强MRI和DWI评价肝细胞癌TACE术后的研究
Evaluation of Treatment Reponse after TACE in Hepatocellular Carcinoma Using GD-EOB-DTPA Enhanced MRI and Diffusion Weighted Imaging
【作者】 刘海峰；
【导师】 雷军强；
【作者基本信息】 兰州大学 ， 临床医学·影像医学与核医学（专业学位）， 2019， 硕士
【摘要】 目的:探究钆塞酸二钠增强MRI和弥散加权成像(DWI)评价肝细胞癌(HCC)经导管肝动脉化疗栓塞术(TACE)后疗效的价值。方法:按照纳入与排除标准前瞻性连续纳入2016年9月至2018年12月在兰州大学第一医院初次接受TACE治疗的96例HCC患者,男、女分别为84、12例,包括115个原发HCC病灶。以CT和/或MRI随访、手术病理为诊断金标准,探究Gd-EOB-DTPA增强MRI和DWI对TACE术后1-2月存活或复发HCC病灶的诊断准确性,并采用ROC曲线分析表观扩散系数(ADC)值对存活或复发病灶的鉴别诊断价值。同时运用卡方检验分析影像学征象包括T1WI信号、T2WI信号、形态、包膜、DWI信号、动脉期增强表现及肝特异期信号诊断TACE术后存活或复发灶的价值。最后,通过测量TACE术后HCC病灶周围3cm以内和非瘤周区域肝组织平扫及肝特异期信噪比值并运用Mann-Whitney U检验比较分析TACE术后局部肝脏功能损伤。结果:(1)金标准证实TACE术后存活病灶29个,肝内复发病灶18个,完全坏死病灶82个。(2)TACE术后HCC存活或复发病灶多呈现出T1WI低信号、T2WI高信号、DWI高信号的表现,89.36%(42/47)增强表现为动脉期强化,91.49%(43/47)肝细胞期未见造影剂摄取呈低信号。(3)Gd-EOB-DTPA增强MRI和DWI诊断TACE术后存活或复发病灶的敏感度、特异度分别为93.62%和91.49%、96.34%和95.12%,两者联合诊断的敏感度和特异度为95.74%、100%。(4)病灶无包膜形成、DWI高信号、动脉期增强表现的影像学征象是判断TACE术后存活或复发的独立重要因素(P<0.05)。(5)Gd-EOB-DTPA增强MRI特异期瘤周区域SNR值为73.22±26.48,低于非瘤周区域肝组织SNR值83.15±29.31,且差异具有明显的统计学意义(P<0.001)。结论:1)TACE术后HCC存活或复发病灶的Gd-EOB-DTPA增强MRI和DWI多表现为T1WI低信号、T2WI和DWI高信号、动脉期强化和肝特异期呈低信号的信号特点。2)Gd-EOB-DTPA增强MRI诊断TACE术后HCC存活或复发病灶的价值较DWI高,但两者联合能提高诊断价值。3)TACE术后病灶无包膜、DWI高信号、动脉期增强表现有助于预测TACE术后病灶存活或复发、坏死。4)Gd-EOB-DTPA增强MRI能有效评价TACE术后局部肝脏功能损伤。
【Abstract】 Objective To investigate the value of Gadolinium Ethoxybenzyl Diethylene-triaminepentaacetic-acid(Gd-EOB-DTPA)enhanced magnetic resonance imaging(MRI)and diffusion weighted imaging(DWI)in evaluating teatment response after transarterial chemoembolization(TACE)in hepatocellular carcinoma(HCC),in order to provide scientific imaging evidences for clinical precise diagnosis and treatment.Material and Methods Nighty-six patients with 115 HCCs who had undergone TACE firstly in the first affiliated hospital of lanzhou university from September 2016 to December 2018 were prospectivelly and consecutively included in our study.The aim of this study was to investigate the diagnostic accuracy of Gd-EOB-DTPA enhanced MRI and DWI,as well as receiver operator characteristics(ROC)curve was used to evaluate the differential diagnosis value of apparent diffusion coefficient(ADC)in detecting residual or recurrent tumors after 1-2 months based on the reference standard of CT and/or MRI follow up,surgery pathology.Morever,imaging symptoms including T1 WI signal,T2 WI signal,morphology,capsule,DWI signal,arterial-phase enhancement performance and hepatobiliary phsase signal were explored in analyzing postoperative residual or recurrent lesions by Chi-square test.Last but not east,regional liver fuction after TACE in HCC were evaluated comparely by measuring the signal-to-noise ratio(SNR)of peritumoral region(surrounded with 3cm)and non-peritumoral tissue region using Mann-Whitney U test.Results(1)Twenty-nine residual tumors,18 hepatic recurrent tumors and 82 necrotic lesion were proved by reference standrad.(2)The residual or recurrent tumors were characteristic with hypointense on T1-weighted image(T1WI),hyperintense on T2 WI and DWI,hyperintense in arterial phase and hypointense on hepatobiliary phsase.(3)The sensitivity and specificity of Gd-EOB-DTPA enhanced MRI and DWI in diagnosing residual or recurrent tumors after TACE in HCC patients were 93.62% and 91.49%,96.34% and 95.12% respectively,as well as the combined sensitivity and specificity were 95.74% and 100%.(4)Lesion capsule,DWI signal,and enhanced performance of arterial phsase signal were important factors in predicting residual orrecurrent tumors(P<0.05).(5)On hepatobiliary phsase of Gd-EOB-DTPA enhanced MRI,the SNR of peritumoral region and non-peritumoral region were 73.22±26.48 vs.83.15±29.31 with P<0.05.Conclusions1)The manifestation of residual or recurrent tumors after TACE in HCC are characteristic with hypointense on T1 WI,hyperintense on T2 WI and DWI,hyperintense in arterial phase and hypointense on hepatobiliary phsase.2)Gd-EOB-DTPA enhanced MRI perform better in diagnosing residual or recurrent tumors in comparasion with DWI,but the combination of both detective methods can improve the diagnostic accuracy.3)Arterial-phase enhancement performance,high DWI signal and capsule are help of diagnosing residual or recurrent tumors after TACE.4)In addition,Gd-EOB-DTPA enhanced MRI can be used in evaluating regional liver fuction after TACE.