DCE-MRI结合DWI评估肝癌介入治疗疗效的应用价值

doi:10.3760/cma.j.issn.1007-1245.2022.05.029

摘要/Abstract

摘要： 目的　探讨动态增强磁共振成像（DCE-MRI）结合扩散加权成像（DWI）评估肝癌介入术后疗效的应用价值。方法　收集江汉大学附属湖北省第三人民医院2019年2月至2020年3月行介入治疗的120例肝癌患者的病例资料进行病例对照研究，按治疗疗效不同分为有效组71例与无效组49例，其中有效组男性52例，女性19例，年龄（53.16±8.47）岁；无效组男性31例，女性18例，年龄（53.21±8.69）岁。两组患者于肝癌介入治疗前、治疗3周后分别行肝脏常规磁共振成像（MRI）、DCE-MRI、DWI检查，测量表观扩散系数（ADC）值、转运常数（K^trans）、细胞外血管外空间的体积分数（Ve）、速率常数（Kep）、肿瘤体积。采用独立样本t检验和配对t检验比较治疗前后不同疗效组的ADC、K^trans、Ve、Kep肿瘤体积的差异，采用Pearson相关性分析ADC差值、K^trans差值、Ve差值、Kep差值与肝癌肿瘤体积差值的相关性，绘制受试者工作特征曲线（ROC）评价ADC、K^trans、Ve、Kep评估肝癌介入治疗疗效的价值。结果　与介入术前相比，介入术后肝癌患者ADC值升高为（1.23±0.14）×10^-3 mm²/s（t=10.970，P<0.05），K^trans降低为（0.18±0.07）min^-1（t=9.090，P<0.05），Kep降低为（0.31±0.06）min^-1（t=11.829，P<0.05），Ve值降低为（0.40±0.05）（t=6.252，P<0.05），肿瘤体积降低为（10.67±2.48）cm³（t=26.683，P<0.05）。治疗有效组ADC差值、K^trans差值、Kep差值、Ve差值、肿瘤体积差值分别为（0.35±0.08）×10^-3mm²/s、（0.24±0.06）min^-1、（0.47±0.12）min^-1、（0.46±0.13）、（10.57±2.34）cm³，均比无效组更高（t=17.525、12.355、16.285、13.835、22.747，均P<0.05）。ADC差值、K^trans差值、Kep差值、Ve差值与肿瘤体积差值呈正相关（r=0.474、0.495、0.375、0.365，均P<0.001），ADC差值、K^trans差值与肿瘤体积差值相关性最高。ADC差值>0.380×10^-3mm²/s时，ROC下面积（AUC）为0.953，95%置信区间（CI）为0.898～0.983（P<0.001），预测肝癌介入治疗疗效灵敏度为91.84%、特异度为91.55%；K^trans差值>0.250 min^-1时，AUC为0.933，95%CI为0.872～0.970，（P<0.001），预测灵敏度为89.80%、特异度为88.73%；ADC、K^trans差值预测肝癌介入术后疗效的效能均较高（均P<0.05）。结论　DCE-MRI联合DWI对肝癌介入术后患者治疗反应的评价有重要临床价值，介入术前后的参数变化值可较直观地反映疗效，为疗效评估提供客观的影像学数据，可有效指导肝癌患者进一步治疗方案的制定。

关键词: 肝癌, 增强磁共振, 扩散加权成像, 介入治疗, 应用价值

Abstract:

Objective　To explore the application value of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) combined with diffusion weighted imaging (DWI) in evaluating the postoperative efficacy of interventional therapy for liver cancer. Methods　The case data of 120 patients with liver cancer who underwent interventional therapy at Hubei No.3 People's Hospital, Jianghan University between February 2019 and March 2020 were collected for case control study. According to the therapeutic efficacies, the patients were divided into an effective group (71 cases) and an ineffective group (49 cases). There were 52 males and 19 females in the effective group, and they were (53.16±8.47) years old. There were 31 males and 18 females in the ineffective group, and they were (53.21±8.69) years old. The liver cancer conventional magnetic resonance imaging (MRI), DCE-MRI, and DWI were performed before interventional therapy for liver cancer and 3 weeks after the treatment in the two groups. The apparent diffusion coefficient (ADC) value, transfer constant (K^trans), volume fraction of extracellular extravascular space (Ve), rate constant (Kep), and tumor volume were measured. The differences in ADC, K^trans, Ve, K_ep, and tumor volume were compared between before and after the treatment and between the two groups by independent-sample t test and paired t test. Pearson correlation analysis was adopted to analyze the correlation of liver cancer volume difference with ADC, K^trans, Ve, and Kepdifferences. Receiver operator characteristic curve (ROC) was drawn to evaluate the value of ADC, K^trans, Ve, and Kep in evaluating the efficacy of interventional therapy for liver cancer. Results　Compared with those before the interventional therapy, the ADC value of patients with liver cancer after intervention was increased to (1.23±0.14) × 10^-3mm²/s (t=10.970, P<0.05), the K^trans was decreased to (0.18±0.07) min^-1 (t= 9.090, P<0.05), the Kep was reduced to (0.31±0.06) min^-1 (t=11.829, P<0.05), the Ve value was declined to (0.40±0.05) (t=6.252, P<0.05), and the tumor volume was reduced to (10.67±2.48) cm³ (t=26.683, P<0.05). The differences of ADC, K^trans, Kep, and Ve and the tumor volume difference were (0.35±0.08) × 10^-3mm²/s, (0.24±0.06) min^-1, (0.47±0.12) min^-1, (0.46±0.13), and (10.57±2.34) cm³ in the effective group, which were higher than those in the ineffective group (t=17.525, 12.355, 16.285, 13.835, and 22.747, all P<0.05). The differences of ADC, K^trans, Kep,and Ve were positively correlated with the tumor volume difference (r=0.474, 0.495, 0.375, and 0.365; all P<0.001); and the correlations between the differences of ADC and K^trans and the tumor volume difference were the highest. When the ADC difference was greater than 0.380 × 10^-3mm²/s, the area under the ROC (AUC) was 0.953, the 95% confidence interval (CI) was 0.898-0.983 (P<0.001), and the sensitivity and specificity of predicting the efficacy of interventional therapy for liver cancer were 91.84% and 91.55%. When the K^trans difference was greater than 0.250 min^-1, the AUC, sensitivity, and specificity were 0.933 (95%CI 0.872-0.970, P<0.001), 89.80%, and 88.73%. The differences of ADC and K^trans were more effective in predicting the postoperative efficacy of interventional surgery for liver cancer (both P<0.05). Conclusions　DCE-MRI combined with DWI has important clinical value in evaluating the treatment response of patients with liver cancer after interventional therapy. The parameter changes before and after interventional therapy can more intuitively reflect the efficacy, provide objective imaging data for the efficacy evaluation, and effectively guide the formulation of further treatment regimen for liver cancer.

Key words: Liver cancer, Dynamic contrast-enhanced magnetic resonance imaging, Diffusion weighted imaging, Interventional therapy, Application value

胡卫, 刘良进. DCE-MRI结合DWI评估肝癌介入治疗疗效的应用价值[J]. 国际医药卫生导报, 2022, 28(5): 719-724.

Hu Wei, Liu Liangjin. DCE-MRI combined with DWI in evaluating efficacy of interventional therapy for liver cancer[J]. International Medicine and Health Guidance News, 2022, 28(5): 719-724.

参考文献

[1] 邓国瑜,陈洁,黄山,等. 基于巴塞罗那分期与香港分期肝细胞肝癌患者不同治疗方案生存率的比较[J]. 肿瘤防治研究,2019,46(4):327-332. DOI:10.3971/j.issn.1000-8578. 2019. 18.1340.

[2] 雷海科,李小升,赵玉兰,等. 原发性肝癌患者生存预后及影响因素分析(附3 106例报告)[J]. 中华消化外科杂志,2020,19(2):179-184. DOI:10.3760/cma.j.issn.1673-9752. 2020.02.010.

[3] 刘家成,熊斌,周晨,等. Ⅲa期乏血供肝癌DEB-TACE综合介入治疗11例[J]. 中国肿瘤临床,2019,46(6):288-292. DOI:10.3969/j.issn.1000-8179.2019.06.200.

[4] 张少平. MRI对原发性肝癌介入术的疗效评估[J]. 中国医学影像学杂志,2019,27(5):397-400. DOI:10.3969/j.issn.1005-5185.2019.05.019.

[5] 张加辉,陈峰,薛星,等. 基于支持向量机的MRI影像组学方法鉴别不同病理分型原发性肝癌的价值[J]. 中华放射学杂志,2018,52(5):333-337. DOI:10.3760/cma.j.issn.1005- 1201.2018.05.003.

[6] 杨亮,顾玉明,鹿皎,等. 超声造影与增强MRI在评价肝癌TACE术后疗效的应用比较[J]. 介入放射学杂志,2019,28(7):682-686. DOI:10.3969/j.issn.1008- 794X. 2019.07.015.

[7] 杨耀文,王志涛,王颖. MR DWI在肝癌TACE术后评估中的应用研究[J]. 实用放射学杂志,2018,34(4):600-602,605. DOI:10.3969/j.issn.1002-1671.2018.04.030.

[8] 陆录,钦伦秀. 美国癌症联合委员会肝癌分期系统(第8版)更新解读[J]. 中国实用外科杂志,2017,37(2):141-145. DOI:10.19538/j.cjps.issn1005-2208.2017.02.10.

[9] 高杰,朱继业. 卫生部«原发性肝癌诊疗规范(2011年版)»解读[J]. 中华普通外科杂志,2012,27(8):693-695. DOI:10.3760/cma.j.issn.1007-631X.2012.08.034.

[10] Ronot M, Bouattour M, Wassermann J, et al. Alternative Response Criteria (Choi, European association for the study of the liver, and modified Response Evaluation Criteria in Solid Tumors [RECIST]) Versus RECIST 1.1 in patients with advanced hepatocellular carcinoma treated with sorafenib [J]. Oncologist, 2014, 19(4):394-402. DOI: 10.1634/theoncologist.2013-0114.

[11] 林清锋,林征宇,陈一平,等. Barcelona临床肝癌分期B期亚分期肝细胞癌患者TACE术后生存分析[J]. 中国介入影像与治疗学,2019,16(5):285-289. DOI:10.13929/j.1672-8475.201809015.

[12] 文军,刘丽,徐向贤,等. 雷替曲塞经TACE治疗原发性肝癌的临床疗效分析[J]. 介入放射学杂志,2019,28(2):175-178. DOI:10.3969/j.issn.1008-794X.2019.02.017.

[13] 查俊豪,陆建,郭金和. 异常凝血酶原联合甲胎蛋白评价原发性肝癌TACE治疗价值[J]. 介入放射学杂志,2019,28(6):591-594. DOI:10.3969/j.issn.1008-794X.2019.06.020.

[14] 郭素引,康立清,刘凤海. DWI、DCE-MRI对局部进展期直肠癌新辅助放化疗疗效的预测价值[J]. 山东医药,2019,59(34):10-13. DOI:10.3969/j.issn.1002- 266X. 2019. 34.003.

[15] 朱正,赵心明,周纯武,等. 治疗前IVIM-DWI预测肝癌介入治疗疗效的价值[J]. 放射学实践,2018,33(5):502-506. DOI:10.13609/j.cnki.1000-0313.2018.05.013.

[16] 唐静,李金锋,刘凤永,等. ADC对TACE即时联合射频消融治疗的孤立性大肝癌预后的预测价值[J]. 中华肝胆外科杂志,2020,26(11):816-820. DOI:10.3760/cma.j.cn113884- 20200218-00072.

[17] 焦志云,胡春洪,杜芳,等. 肺腺癌DCE-MRI渗透性参数的定量分析:自由呼吸法和屏气法对照研究[J]. 放射学实践,2019,34(8):879-884. DOI:10.13609/j.cnki.1000-0313. 2019.08.010.

[18] 尤威,杨志健,叶飞.微循环阻力指数用于早期预测冠心病患者经皮冠状动脉介入术后微循环损伤[J].中华心血管病杂志,2019,47(11):894-900. DOI:10.3760/cma.j.issn. 0253-3758.2019.11.008.