磁共振表观弥散系数变化率对肝细胞肝癌患者单次TACE术后疗效评价的应用价值

Application value of the change ratio of apparent diffusion coefficient in the therapeutic evaluation of hepatocellular carcinoma treated by single transcatheter arterial chemoembolization

    摘要
  • 摘要:
    目的 探讨磁共振表观弥散系数（ADC）变化率（即ΔADC）在肝细胞肝癌（HCC）单次经导管肝动脉化疗栓塞术（TACE）术后疗效评价中的应用价值。
    方法 选择48例确诊为中晚期HCC并于TACE术前、术后1个月接受常规CT、MRI扫描以及MRI弥散加权成像和动态增强扫描的患者，建立所有患者的随访数据，随访中以肿瘤出现进展为随访结束点，记录患者治疗后肿瘤无进展生存期（PFS）；以TACE术后1个月再次行数字减影血管造影（DSA）的肿瘤染色结果作为“金标准”，将病灶按治疗效果分为良好组、中等组及差组3组，并根据各组PFS绘制生存曲线。分别比较ΔADC、CT及MRI 3种方法对TACE术后疗效的判定价值，并与“金标准”的一致性进行检验。
    结果 48例患者共56个病灶纳入分析，以“金标准”评价治疗效果，结果：良好组30个、中等组16个、差组10个，3组间生存曲线差异有统计学意义（χ2=29.89，P < 0.01），中位PFS分别为7.5、4.0和1.1个月；TACE术后各组ADC均升高，3组间ΔADC差异有统计学意义（F=22.41，P < 0.01），且3组间生存曲线差异亦有统计学意义（χ2=26.57，P < 0.01），中位PFS分别为7.5、4.6和1.8个月。经Kappa检验，ΔADC与“金标准”疗效评价方法具有一致性（Kappa值为0.542，P < 0.01）；以MRI和CT评价治疗效果，其与“金标准”的一致性较差（Kappa值分别为0.328和0.260，P均 < 0.05），3组间生存曲线仅MRI评价方法显示差异有统计学意义（χ2=30.623，P < 0.01）。
    结论 ΔADC能及时、客观地评价TACE治疗效果，对指导患者术后的后续治疗有重要临床意义。

     

    Abstract:
    Objective To explore the application value of the change ratio of the apparent diffusion coefficient(ΔADC) in the therapeutic evaluation of hepatocellular carcinoma(HCC) treated by single transcatheter arterial chemoembolization(TACE).
    Methods Forty-eight patients diagnosed with advanced HCC underwent diffusion-weighted imaging, dynamic enhanced MRI, and CT before and one month after TACE. The follow-up data for all selected patients were accumulated, and the disease progression in the follow-up was considered the end point. The progression-free survival of every patient was recorded after TACE. The responses one month after TACE were assessed via digital subtraction angiography, ΔADC, MRI, and CT, of which DSA was considered the "gold standard." The groups were divided into three groups: good, middle, and bad. The PFS curves were then plotted. The consistency of the other three evaluation methods with the "gold standard" was evaluated by kappa test.
    Results Fifty-six lesions were found in 48 patients according to the DSA results, where 30, 16, and 10 lesions belonged to the good, middle, and bad groups, respectively. The survival curves among the 3 groups were statistically significant(χ2=29.89, P < 0.01), and the median PFSs of the good, middle, and bad groups were 7.5, 4.0, and 1.1 months, respectively. The ΔADC results indicated that the ADC values generally increased after a single TACE; the ΔADC and survival curves among the 3 groups were also statistically significant(χ2=26.57, P < 0.01);the median PFSs for the good, middle, and bad groups were 7.5, 4.6, and 1.8 months, respectively. The kappa test shows that the ΔADC was perfectly consistent with the "gold standard"(kappa=0.542, P < 0.01), but the MRI and CT were poorly consistent with the "gold standard"(Kappa=0.328, 0.260, P < 0.05). Only the MRI was statistically significant(χ2=30.623, P < 0.01) in the survival curve.
    Conclusion The ΔADC can evaluate the efficacy of TACE timely and objectively, and the ΔADC is clinically significant in guiding the subsequent treatment after a single TACE.

     

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