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目的探讨MR扩散加权成像(DWI)在原发性肝癌经导管动脉化疗栓塞术(TACE)疗效动态评价中的作用。方法在1.5TGE Signa Twin speed MR机上,取扩散敏感梯度因子(b值)为0及800s/mm2,利用固定参数组合的自旋回波-平面回波(SE-EPI)序列对首次行TACE治疗的25例肝癌肿块分别于术前24~48h、术后36~48h、术后7~10d、术后30~38d内各进行1次DWI,对每次的图像进行后处理,计算出每例肝癌每个时点的表观扩散系数(ADC值),对各个时点的ADC值进行对比研究,并结合第1次TACE术后与第2次TACE术前肿瘤的血管造影染色及碘油沉积的改变判断肿瘤的复发情况。结果术前24~48h、术后36~48h、术后7~10d、术后30~38d组的ADC值分别为(1.376±0.012)×10-3mm2/s、(1.598±0.012)×10-3mm2/s、(1.723±0.012)×10-3mm2/s、(1.684±0.012)×10-3mm2/s。术后各组肝癌组织的ADC值较术前明显升高(P<0.05);术后7~10d、术后30~38d组的ADC值较术后36~48h组明显升高(P<0.05);术后30~38d的ADC值较术后7~10d组明显降低(P<0.05)。将第1次TACE术后与第2次TACE术前的造影片及碘油沉积片对比见术后30~38d ADC值下降的肝癌病例都有不同程度的复发,ADC值下降明显的复发也最为明显。结论利用MR DWI技术对肝癌组织的ADC值进行动态观察,可以评价肝癌TACE术后癌组织的坏死、复发情况。
Objective To investigate the role of MR diffusion weighted imaging (DWI) in the dynamic assessment of therapeutic effect of transcatheter arterial chemoembolization (TACE) in primary hepatocellular carcinoma. Methods Spread-sensitive gradient factor (b value) was 0 and 800s / mm2 on a 1.5TGE Signa Twin-speed MR machine. Spin echo-plane echo (SE-EPI) Twenty-five cases of HCC were treated with DWI at 24-48 h, 36-48 h, 7-10 d, 30 d-38 d after operation, respectively. The images of each liver were processed to calculate the liver cancer The apparent diffusion coefficient (ADC value) at each time point was used to compare the ADC value at each time point. Combined with the first TACE and the second TACE preoperative tumor angiography and lipiodol deposition Change to determine the recurrence of the tumor. Results The ADC values at 24-48 hours, 36-48 hours, 7-10 days and 30-38 days after operation were (1.376 ± 0.012) × 10-3 mm2 / s and (1.598 ± 0.012) × 10- 3mm2 / s, (1.723 ± 0.012) × 10-3mm2 / s, (1.684 ± 0.012) × 10-3mm2 / s. The ADC value of postoperative HCC tissues in each group was significantly higher than that before operation (P <0.05). The ADC value of postoperative 7 ~ 10 days and postoperative 30 ~ 38 days group was significantly higher than that of postoperative 36 ~ 48 hours group (P <0.05) ). The ADC value at 30 ~ 38 days after operation was significantly lower than that at 7 ~ 10 days after operation (P <0.05). Comparing the first TACE with the second before TACE and the lipiodol deposition, the recurrence of hepatocellular carcinoma with ADC value decreased from 30 to 38 days after operation was found, and the recurrence of ADC value was the most obvious. Conclusion MR DWI can be used to evaluate the value of ADC in liver cancer tissue to evaluate the degree of necrosis and relapse after TACE.