扩散加权成像评价射波刀治疗小肝癌早期疗效的价值

摘要/Abstract

摘要： 目的探讨磁共振扩散加权成像评估射波刀治疗小肝癌早期疗效的价值。方法收集2017年9月至12月解放军总医院第五医学中心临床诊断为小肝癌并进行射波刀治疗的23例患者(24个病灶)的临床资料。患者分别于射波刀治疗前、治疗后1个月、3个月及6~12个月行肝脏MRI平扫及DWI扫描,治疗前及治疗后3个月、6~12个月同时行磁共振动态增强扫描。于治疗后6~12个月按照改良后的实体肿瘤疗效评价标准(mRECIST)来判断肿瘤完全坏死及术后残留活性。分别测量射波刀治疗前及治疗后各个时期残留活性组织、完全坏死组织及正常肝组织ADC值。选择配对样本t检验分别对治疗后1、3个月肿瘤完全坏死病灶和治疗前以及正常肝组织ADC值的差异进行比较,采用ROC曲线对ADC值预测治疗后肿瘤术后完全坏死的效能进行评价。结果共24个病灶,23个病灶治疗后完全坏死,1个病灶残留活性。完全坏死的肿瘤病灶治疗后1个月及3个月的ADC值分别为(1.652±0.353)和(1.802±0.408),与治疗前的(1.316±0.304)比较,差异均有统计学意义(P<0.05);正常肝组织治疗后1和3个月的ADC值分别为(1.259±0.563)和(1.252±0.268)治疗前的(1.269±0.082)比较,差异无统计学意义(P>0.05)。ADC值用于预测射波刀治疗后完全坏死组织的ROC曲线下面积为0.830,当1.29×10^-3 mm²/s为阈值进行诊断时,诊断的灵敏度和特异度分别为85.7%和47.6%。结论 ADC值在射波刀治疗后1个月就可以将小肝癌治疗后的坏死成分与肿瘤活性成分区分开来,可早期评价射波刀治疗小肝癌的治疗效果。

关键词: 小肝癌, 磁共振成像, 射波刀

Abstract: Objective To investigate the value of diffusion-weighted imaging (DWI) for evaluating short-term efficacy of cyber knife in the treatment of small hepatocellular carcinoma.Methods Twenty-three patients (24 lesions) diagnosed with small hepatocellular carcinoma in our hospital from February 2017 to December 2017 were enrolled. All the 23 patients underwent non-enhanced magnetic resonance imaging (MRI) scans and DWI scans of the liver before cyber knife, 1 month, 3 months and 6-12 months after cyber knife; as well as dynamic contrast-enhanced MRI scans of the liver before treatment, 3 months and 6-12 months after treatment. According to the modified response evaluation criteria in solid tumors, the complete necrosis and residual activity of tumor 6-12 months after cyber knife were assessed. The apparent diffusion coefficient (ADC) values of residual active tissue, necrosis in tumor and normal liver tissue at different times were measured. Paired t test was used to compare ADC values of tumor necrosis lesions and normal liver tissues before and after treatment, and receiver operating characteristic (ROC) curve was used to evaluate the efficacy of ADC values in predicting complete tumor necrosis after treatment. Results Among the 24 lesions, 23 lesions were completely necrotic, and active tissues were found in 1 lesion after treatment. The ADC values of the completely necrotic tumor tissues 1 month and 3 months after treatment were higher than that before treatment, with statistical difference (P<0.05). There were no statistically significant differences in ADC of normal liver tissue 1 month or 3 months after treatment compared with that before treatment (P>0.05). The area under the ROC curve of ADC value for predicting the complete necrosis in tumor tissues after cyber knife was 0.830. And the cut-off value of ADC was 1.29×10^-3 mm²/s, with sensitivity of 85.7% and specificity of 47.6%.Conclusion The ADC value helps to distinguish the necrotic component from the active component of small hepatocellular carcinoma 1 month after cyber knife, and can be used to evaluate the short-term efficacy of cyber knife in small hepatocellular carcinoma.

Key words: Small hepatocellular carcinoma, Magnetic resonance imaging, Cyber knife

余海龙, 史芳芳, 蔡剑鸣, 张见增, 胡海东, 郑增, 董景辉. 扩散加权成像评价射波刀治疗小肝癌早期疗效的价值[J]. 肝脏, 2021, 26(2): 162-166.

YU Hai-long, SHI Fang-fang, CAI Jian-ming, ZHANG Jian-zeng, HU Hai-dong, ZHENG Zeng, DONG Jing-hui. The value of diffusion-weighted imaging for evaluating short-term efficacy of cyber knife in the treatment of small hepatocellular carcinoma[J]. Chinese Hepatolgy, 2021, 26(2): 162-166.

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