磁共振成像评估原发性肝癌TACE术后疗效价值的研究
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摘要
第一部分
磁共振成像在原发性肝癌化疗栓塞术前及术后疗效评估方面的应用研究
目的：探讨利用磁共振成像技术定性分析术前影像特征对术后疗效的预测作用及TACE术后患者疗效评估的应用价值。
方法：通过回顾性分析89例患者113个HCC病灶,术前、术后行常规MRI、动态增强及DWI序列(b取0、800s/mm2)扫描,并与后续随访及部分DSA造影对比,从术前肿瘤T1WI信号特征、病灶大小、有无包膜、供血血管来源、强化程度；术后根据T1、T2、DWI信号特征及早动脉期有无强化、复发灶形态,结合CT平扫评估碘油缺失位置及碘油密实程度预测TACE术后的近期疗效。
结果：术前肿瘤动脉供血型占有效治疗组的65.1%(56/86)、规则供血型占有效治疗组的61.6%(53/86)、病灶直径<5cm占有效治疗组的74.4%(64/86)、T1WI为高信号、有包膜病灶介入治疗有效；术后碘油填充密实、碘油缺失位置位于瘤灶中央、TlWI为高信号、T2WI为低信号者、增强扫描早动脉期无强化的病灶术后可达到更长时间的稳定状态。
结论：磁共振扫描技术能一定程度上可评估肝癌TACE治疗的近期疗效,对于原发性肝癌化疗栓塞术后疗效具有重要的提示和评估作用。
第二部分
磁共振ADC值定量评估原发性肝癌TACE术近期疗效的临床应用价值研究
目的：探讨利用磁共振表观扩散系数(ADC)值定量评估HCC化疗栓塞术后近期疗效的临床应用价值。
方法：通过回顾性分析89例患者113个病灶术前、术后的患者行常规MRI、动态增强及DWI序列(b取0、800s/mm2)扫描,并与后续随访及部分DSA造影对比,分析TACE术后病灶整体及碘油沉积区内肿瘤坏死区和肿瘤残存活性组织灶在DWI成像序列的信号特征,分别测量并记录上述各个区域的ADC值,用受试者工作特征曲线(ROC)分析ADC值鉴别肿瘤残存组织和坏死组织的价值及敏感性。
结果：①正常肝实质的ADC值为(1.34±0.13)×10-3mm2/s,整体肝癌组织为(1.24±0.13)×10-3mm2/s,两者有统计学意义；②介入治疗后1月A组、B组、C组的ADC值分别为(1.67±0.24)×10-3mm2/s、(1.48±0.14)×10-3mm2/s、(1.21±0.37)×10-3mm2/s,A组、 B组所示各瘤灶ADC值较术前升高,C组则较术前无统计学差别,三组瘤灶ADC值之间差别比较均有统计学意义；③A组、C组术后1月、三月术后整体瘤灶ADC值比较无统计学意义,B组术后3月ADC值低于1月份,两者比较有统计学意义④用ROC分析ADC值区分肿瘤内的坏死组织和活性组织能力,以1.54×10-3mm2/s为阈值,诊断肿瘤病灶内坏死组织的敏感性为81.0%,特异性为80.3%。
结论：通过肿瘤内部ADC值的变化差异能定量坏死和活性组织成分,从而进行有效区分和鉴别,可用于TACE术后临床疗效的随访观测,为及时有效的后续巩固治疗提供影像依据。
第三部分
原发性肝癌TACE术后完全缓解病灶磁共振ADC值可重复性及一致性研究
目的：评估原发性肝癌介入术后完全缓解病灶磁共振ADC值测量的可重复性和一致性,为临床应用提供参考。
方法：对21个完全缓解病灶在第1月、3月、6月同一医师同一序列测量ADC值、不同医师间隔1周测量病灶的ADC值,通过计算组内相关系数(ICC)值及绘制Bland-Altman图表确定ADC值测量的可重复性及一致性。ICC值大于0.75表示信度良好,可重复性高,75%的位点位于Bland-Altman图95%的置信区间的参考线内其一致性高。
结果：A医师1、3、6月测量ICC值分别为0.928、0.878、0.934；B医师1、3、6月测量ICC值分别为0.873、0.940、0.871,一周前不同时间A、B医师1、3、6月测量ICC值分别为0.854、0.940、0.960；一周后不同时间A、B医师1、3、6月测量ICC值分别为：0.788、0.945、0.858,均大于0.75,提示可信度较高,可重复性强。90%的位点Bland-Altman图95%的置信区间的参考线内,数值测量的可重复性高。
结论：完全缓解病灶的ADC值稳定,测量具有较高的一致性和可重复性,可以动态观察原发性肝癌介入治疗后病灶的稳定程度,可及时有效的评估巩固治疗时机
Part1
The Application of MRI Scan in Evaluating the Efficacy of TACE and in forcasting before the Procedure
Objective:Investigate the predicting role of MRI in evaluating the therapeutic efficacy and the value of follow-up after transarterial chemoembolization.
Method:89cases analyzed Retrospectively, were113lesions'MRI features before and after TACE including the plain scan, dynamic contrast enhanced scan and DWI serials, were studied with the hepatic artery digital subtraction angiography and followed-up. Short-term therapetic efficay of trasarterial chemoembolization were evaluated through the change of MRI contrast enhanced imaging, T1weighted imaging, lesion size, with or without capsule, supplying vasculature, lipiodol deficiency and recurred lesion shape.
Result:Lesions with the feature of evident enhancement, high signal in T1WI, low signal in T2WI, size less than5cm, with envelope, simple supplying vasculature, dense lipiodol sedimentation, consistent signal in in-phase and out-phase imaging hold expecting therapeutic efficacy of transarterial chemoembolization.
Conclusion:MRI can accurately evaluate the short-term efficacy of transarterial chemoembolization and plays an important role in ptedicting and evaluating post procedure efficacy.
Part2
Clinical Study of the Application of MRI's ADC Value in evaluating the Short Term Efficacy of Hepatocellular Carcinoma after TACE
Objective:Investigate the clinical value of apparent diffusion coefficient in evaluating the short term therapeutic efficacy of hepatocellular carcinoma after chemoembolization.
Method:89cases analyzed Retrospectively, were113lesions' MRI features including the plain scan, dynamic contrast enhanced scan and DWI serials(b value was0,800s/mm2), compared with the follow-up change and hepatic artery digital subtraction angiography, record and studied the ADC value of viable and necrotic tumor and their DWI feature, appraised their value in and sensitivity in differentiating necrotic and viable tumor.
Results:①ADC value of normal liver tissue and viable tumor was (1.34±0.13)×10-3mm2/s and (1.24±0.13)×10-3mm2/s, their diffenrence held evident statistical significance.②ADC value in group A, group B, group C after1month of the procedure were (1.67±0.24)×10-3mm2/s,(1.48±0.14)×10-3mm2/s,(1.21±0.37)×10-3mm2/s. ADC value in group A and group B after the procedure was higher than the value before the procedure. The difference of three groups ADC value hold high statistical significance.③ADC value of1month,3month in group A and group C had no difference. ADC value of3month was lower than1month in group C.4ROC analysis exhibit ADC value of1.54×10-3mm2/s was the threshold in appreciating viable and necrotic tumor. The sensitivity was81.0%, specifity was80.3%.
Conclusion:The parameter of ADC value can differentiate viable and necrotic tumor and hold high value in the follow-up of hepatocellular carcinoma after trancarterial chemoembolization.
Part3
Repeatability and consistency study of magnetic resonance apparent diffusion values of the completely remission lesions of primary liver cancer after TACE
Objective:To investigate MR ADC value measurement repeatability and consistency of the primary liver cancer with complete remission lesions after TACE.
Methods:The same radiologist measured the ADC values in the same sequence of the complete remission lesions in the first,third,fifth month,and another radiologist repeated the measured again interval of1week. According to calculate the intraclass correlation coefficient (ICC) value and draw Bland-Altman graph to determine the repeatability and consistency of the ADC value measurement.The ICC values is greater than0.75indicates good reliability and high repeatability,75%of the sites were located in the Bland-Altman graph of the95%confidence interval indicates its high consistency within the reference line.
Results:The ICC values of A radiologist measured in the first,third,fifth month were0.928,0.878,0.934; The ICC values of B radiologist measured in the first, third,fifth month were0.873,0.940,0.871,the ICC values measurement by A, B radiologist at different times a week before in the first,third,fifth month were0.854,0.940,0.960; he ICC values measurement by A, B radiologist at different times a week later in the first,third,fifth month were:0.788,0.945,0.858, all of them were greater than0.75, suggesting the high credibility and repeatability90%of the sites were located in the Bland-Altman graph of the95%confidence interval indicates its high consistency within the reference line.
Conclusion:The stable ADC values which are measured with high repeatability and consistency of complete remission lesions can dynamically observe the degree of stability lesions of primary liver cancer after interventional treatment and help to assess the consolidated treatment timely.
磁共振成像在原发性肝癌化疗栓塞术前及术后疗效评估方面的应用研究
目的：探讨利用磁共振成像技术定性分析术前影像特征对术后疗效的预测作用及TACE术后患者疗效评估的应用价值。
方法：通过回顾性分析89例患者113个HCC病灶,术前、术后行常规MRI、动态增强及DWI序列(b取0、800s/mm2)扫描,并与后续随访及部分DSA造影对比,从术前肿瘤T1WI信号特征、病灶大小、有无包膜、供血血管来源、强化程度；术后根据T1、T2、DWI信号特征及早动脉期有无强化、复发灶形态,结合CT平扫评估碘油缺失位置及碘油密实程度预测TACE术后的近期疗效。
结果：术前肿瘤动脉供血型占有效治疗组的65.1%(56/86)、规则供血型占有效治疗组的61.6%(53/86)、病灶直径<5cm占有效治疗组的74.4%(64/86)、T1WI为高信号、有包膜病灶介入治疗有效；术后碘油填充密实、碘油缺失位置位于瘤灶中央、TlWI为高信号、T2WI为低信号者、增强扫描早动脉期无强化的病灶术后可达到更长时间的稳定状态。
结论：磁共振扫描技术能一定程度上可评估肝癌TACE治疗的近期疗效,对于原发性肝癌化疗栓塞术后疗效具有重要的提示和评估作用。
第二部分
磁共振ADC值定量评估原发性肝癌TACE术近期疗效的临床应用价值研究
目的：探讨利用磁共振表观扩散系数(ADC)值定量评估HCC化疗栓塞术后近期疗效的临床应用价值。
方法：通过回顾性分析89例患者113个病灶术前、术后的患者行常规MRI、动态增强及DWI序列(b取0、800s/mm2)扫描,并与后续随访及部分DSA造影对比,分析TACE术后病灶整体及碘油沉积区内肿瘤坏死区和肿瘤残存活性组织灶在DWI成像序列的信号特征,分别测量并记录上述各个区域的ADC值,用受试者工作特征曲线(ROC)分析ADC值鉴别肿瘤残存组织和坏死组织的价值及敏感性。
结果：①正常肝实质的ADC值为(1.34±0.13)×10-3mm2/s,整体肝癌组织为(1.24±0.13)×10-3mm2/s,两者有统计学意义；②介入治疗后1月A组、B组、C组的ADC值分别为(1.67±0.24)×10-3mm2/s、(1.48±0.14)×10-3mm2/s、(1.21±0.37)×10-3mm2/s,A组、 B组所示各瘤灶ADC值较术前升高,C组则较术前无统计学差别,三组瘤灶ADC值之间差别比较均有统计学意义；③A组、C组术后1月、三月术后整体瘤灶ADC值比较无统计学意义,B组术后3月ADC值低于1月份,两者比较有统计学意义④用ROC分析ADC值区分肿瘤内的坏死组织和活性组织能力,以1.54×10-3mm2/s为阈值,诊断肿瘤病灶内坏死组织的敏感性为81.0%,特异性为80.3%。
结论：通过肿瘤内部ADC值的变化差异能定量坏死和活性组织成分,从而进行有效区分和鉴别,可用于TACE术后临床疗效的随访观测,为及时有效的后续巩固治疗提供影像依据。
第三部分
原发性肝癌TACE术后完全缓解病灶磁共振ADC值可重复性及一致性研究
目的：评估原发性肝癌介入术后完全缓解病灶磁共振ADC值测量的可重复性和一致性,为临床应用提供参考。
方法：对21个完全缓解病灶在第1月、3月、6月同一医师同一序列测量ADC值、不同医师间隔1周测量病灶的ADC值,通过计算组内相关系数(ICC)值及绘制Bland-Altman图表确定ADC值测量的可重复性及一致性。ICC值大于0.75表示信度良好,可重复性高,75%的位点位于Bland-Altman图95%的置信区间的参考线内其一致性高。
结果：A医师1、3、6月测量ICC值分别为0.928、0.878、0.934；B医师1、3、6月测量ICC值分别为0.873、0.940、0.871,一周前不同时间A、B医师1、3、6月测量ICC值分别为0.854、0.940、0.960；一周后不同时间A、B医师1、3、6月测量ICC值分别为：0.788、0.945、0.858,均大于0.75,提示可信度较高,可重复性强。90%的位点Bland-Altman图95%的置信区间的参考线内,数值测量的可重复性高。
结论：完全缓解病灶的ADC值稳定,测量具有较高的一致性和可重复性,可以动态观察原发性肝癌介入治疗后病灶的稳定程度,可及时有效的评估巩固治疗时机
Part1
The Application of MRI Scan in Evaluating the Efficacy of TACE and in forcasting before the Procedure
Objective:Investigate the predicting role of MRI in evaluating the therapeutic efficacy and the value of follow-up after transarterial chemoembolization.
Method:89cases analyzed Retrospectively, were113lesions'MRI features before and after TACE including the plain scan, dynamic contrast enhanced scan and DWI serials, were studied with the hepatic artery digital subtraction angiography and followed-up. Short-term therapetic efficay of trasarterial chemoembolization were evaluated through the change of MRI contrast enhanced imaging, T1weighted imaging, lesion size, with or without capsule, supplying vasculature, lipiodol deficiency and recurred lesion shape.
Result:Lesions with the feature of evident enhancement, high signal in T1WI, low signal in T2WI, size less than5cm, with envelope, simple supplying vasculature, dense lipiodol sedimentation, consistent signal in in-phase and out-phase imaging hold expecting therapeutic efficacy of transarterial chemoembolization.
Conclusion:MRI can accurately evaluate the short-term efficacy of transarterial chemoembolization and plays an important role in ptedicting and evaluating post procedure efficacy.
Part2
Clinical Study of the Application of MRI's ADC Value in evaluating the Short Term Efficacy of Hepatocellular Carcinoma after TACE
Objective:Investigate the clinical value of apparent diffusion coefficient in evaluating the short term therapeutic efficacy of hepatocellular carcinoma after chemoembolization.
Method:89cases analyzed Retrospectively, were113lesions' MRI features including the plain scan, dynamic contrast enhanced scan and DWI serials(b value was0,800s/mm2), compared with the follow-up change and hepatic artery digital subtraction angiography, record and studied the ADC value of viable and necrotic tumor and their DWI feature, appraised their value in and sensitivity in differentiating necrotic and viable tumor.
Results:①ADC value of normal liver tissue and viable tumor was (1.34±0.13)×10-3mm2/s and (1.24±0.13)×10-3mm2/s, their diffenrence held evident statistical significance.②ADC value in group A, group B, group C after1month of the procedure were (1.67±0.24)×10-3mm2/s,(1.48±0.14)×10-3mm2/s,(1.21±0.37)×10-3mm2/s. ADC value in group A and group B after the procedure was higher than the value before the procedure. The difference of three groups ADC value hold high statistical significance.③ADC value of1month,3month in group A and group C had no difference. ADC value of3month was lower than1month in group C.4ROC analysis exhibit ADC value of1.54×10-3mm2/s was the threshold in appreciating viable and necrotic tumor. The sensitivity was81.0%, specifity was80.3%.
Conclusion:The parameter of ADC value can differentiate viable and necrotic tumor and hold high value in the follow-up of hepatocellular carcinoma after trancarterial chemoembolization.
Part3
Repeatability and consistency study of magnetic resonance apparent diffusion values of the completely remission lesions of primary liver cancer after TACE
Objective:To investigate MR ADC value measurement repeatability and consistency of the primary liver cancer with complete remission lesions after TACE.
Methods:The same radiologist measured the ADC values in the same sequence of the complete remission lesions in the first,third,fifth month,and another radiologist repeated the measured again interval of1week. According to calculate the intraclass correlation coefficient (ICC) value and draw Bland-Altman graph to determine the repeatability and consistency of the ADC value measurement.The ICC values is greater than0.75indicates good reliability and high repeatability,75%of the sites were located in the Bland-Altman graph of the95%confidence interval indicates its high consistency within the reference line.
Results:The ICC values of A radiologist measured in the first,third,fifth month were0.928,0.878,0.934; The ICC values of B radiologist measured in the first, third,fifth month were0.873,0.940,0.871,the ICC values measurement by A, B radiologist at different times a week before in the first,third,fifth month were0.854,0.940,0.960; he ICC values measurement by A, B radiologist at different times a week later in the first,third,fifth month were:0.788,0.945,0.858, all of them were greater than0.75, suggesting the high credibility and repeatability90%of the sites were located in the Bland-Altman graph of the95%confidence interval indicates its high consistency within the reference line.
Conclusion:The stable ADC values which are measured with high repeatability and consistency of complete remission lesions can dynamically observe the degree of stability lesions of primary liver cancer after interventional treatment and help to assess the consolidated treatment timely.
引文
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