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目的探讨3.0 T磁共振扩散加权成像(DWI)表观扩散系数(ADC)值结合MRI动态增强对肝脏转移瘤的化疗疗效早期评估价值。方法对52例(81个病灶)临床或病理证实肝转移瘤患者在化疗前、化疗2个疗程、4个疗程后分别进行MRI常规平扫及增强扫描,同时行DWI并测得相应病灶ADC值。依据RECIST标准作为肝脏转移瘤化疗疗效评价标准。运用受试者工作特征(ROC)曲线评估2个疗程后ADC值变化率诊断效能,获得ADC值变化率最佳阈值(cut-off value)。结果治疗前ADC均值:有效组为(1.105±0.332)×10-3mm2/s,无效组为(1.289±0.354)×10-3mm2/s,两组间差异无统计学意义(P=0.077)。化疗2个疗程后ADC均值:有效组为(1.378±0.477)×10-3mm2/s,无效组为(1.378±0.477)×10-3mm2/s,两组间差异有统计学意义(P=0.03)。化疗4个疗程后ADC均值:有效组为(1.898±0.484)×10-3mm2/s,无效组为(1.382±0.457)×10-3mm2/s,两组间差异有显著统计学意义(P=0.00)。有效组ADC值变化率与无效组ADC值变化率比较差异有统计学意义(P=0.000)。当化疗2个疗程后ADC值升高19.59%时,敏感性为79.2%,特异性为78.9%,ROC曲线下面积0.844。结论动态监测ADC值在化疗过程中的变化或将成为早期预测肝脏转移瘤化疗疗效的一种量化指标。
Objective To investigate the value of 3.0 T MR diffusion weighted imaging (DWI) with apparent diffusion coefficient (ADC) combined with MRI dynamic enhancement in the early evaluation of chemotherapeutic efficacy of liver metastases. Methods Fifty-two patients (81 lesions) with pathologically confirmed liver metastases were treated with 2 courses of chemotherapy and 2 courses of chemotherapy before and after 4 courses of treatment. The patients underwent DWI and DWI and the corresponding ADC value . According to RECIST standard as liver metastases chemotherapy efficacy evaluation criteria. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic efficiency of the change rate of ADC value after two courses of treatment to obtain the best cut-off value of the change rate of ADC value. Results The average ADC value before treatment was (1.105 ± 0.332) × 10-3mm2 / s in the effective group and (1.289 ± 0.354) × 10-3mm2 / s in the invalid group. There was no significant difference between the two groups (P = 0.077). The average ADC value after two courses of chemotherapy was (1.378 ± 0.477) × 10-3mm2 / s in the effective group and (1.378 ± 0.477) × 10-3mm2 / s in the invalid group, with significant difference between the two groups (P = 0.03 ). After 4 courses of chemotherapy, the mean of ADC was (1.898 ± 0.484) × 10-3mm2 / s in effective group and (1.382 ± 0.457) × 10-3mm2 / s in invalid group, with significant difference between the two groups (P = 0.00). There was significant difference between the effective rate of change of ADC value and ineffective change of ADC value (P = 0.000). When the ADC value increased by 19.59% after two courses of chemotherapy, the sensitivity was 79.2%, the specificity was 78.9% and the area under the ROC curve was 0.844. Conclusion The dynamic change of ADC value during chemotherapy may be a quantitative indicator of the early effect of chemotherapy for liver metastases.