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目的评价MR扩散加权成像(DWI)在肝癌化疗栓塞术后随访中的临床应用价值。资料与方法采用自旋回波-回波平面成像(SE-EPI)、扩散系数b=0和500s/mm2对肝癌化疗栓塞术后患者肝脏行DWI,计算DWI、T2WI中新发肿瘤病灶-肝脏的对比信噪比(CNR),观察上腹部CT增强扫描和肝脏DSA图像,并与DWI相对照,分析肝癌化疗栓塞术后碘油沉积区、肿瘤坏死区和肿瘤复发/残留区等在DWI上的信号特点,并测量上述区域的表观扩散系数(ADC)值,用受试者工作特征曲线(receiver operating curveanalysis,ROC)分析ADC值鉴别肿瘤活性和坏死组织的价值。结果新发肿瘤病灶在DWI和T2WI上的CNR分别为46.36±19.49和33.24±17.26,两者差异有统计学意义(t=2.400,P=0.025);在DWI上,肿瘤坏死组织呈低信号,肿瘤活性组织呈高信号,而碘油沉积区呈低、等或稍高信号。用ROC分析ADC值区分肿瘤内的坏死组织和活性组织能力,以1.84×10-3mm2/s为阈值,诊断坏死组织的敏感性为92.3%,特异性为100%。结论MRDWI能够敏感发现新发肿瘤,ADC值能有效区分肿瘤内部坏死和活性组织成分,可用于肝癌化疗栓塞术后的临床随访。
Objective To evaluate the clinical value of MR diffusion weighted imaging (DWI) in the follow-up of chemoembolization of hepatocellular carcinoma. Materials and Methods DWI was performed on the liver of patients with hepatocellular carcinoma after chemoembolization using spin echo-echo planar imaging (SE-EPI), diffusion coefficient b = 0 and 500 s / mm2, and the newly diagnosed tumor lesions in the DWI and T2WI Comparing the signal-to-noise ratio (CNR), CT scan of upper abdomen and DSA image of liver were observed and compared with DWI. The areas of lipiodol deposition, tumor necrosis and tumor recurrence / (ADC) values of the above regions were measured, and ADC value of receiver operating curve analysis (ROC) was used to identify the tumor activity and the value of necrotic tissue. Results The CNR of newly diagnosed tumor lesions on DWI and T2WI were 46.36 ± 19.49 and 33.24 ± 17.26 respectively, with significant difference (t = 2.400, P = 0.025). On DWI, tumor necrosis tissue showed low signal intensity, Tumor active tissue showed high signal, while the lipiodol deposition zone was low, equal or slightly higher signal. ROC analysis of ADC value of differentiated tumor necrosis and active tissue capacity to 1.84 × 10-3mm2 / s threshold for the diagnosis of necrotic tissue was 92.3% sensitivity and specificity of 100%. Conclusion MRDWI can detect newly emerging tumor sensitively. The ADC value can effectively distinguish the necrotic and active tissue components of the tumor. It can be used in clinical follow-up after chemoembolization of liver cancer.