發(fā)布時(shí)間：2018-05-29 21:28

  本文選題：TACE術(shù)后 + 原發(fā)性肝癌　； 參考：《吉林大學(xué)》2014年碩士論文

【摘要】：目的：探索原發(fā)性肝癌經(jīng)導(dǎo)管動(dòng)脈化療栓塞（transarterialchemoembolization，TACE）術(shù)后1個(gè)月的表觀彌散系數(shù)值(apparentdiffusion coefficient，， ADC)及門靜脈期增強(qiáng)信號(hào)強(qiáng)度（venousenhancement，VE）的變化程度與TACE術(shù)后6個(gè)月按照RECIST標(biāo)準(zhǔn)評(píng)估腫瘤治療療效的相關(guān)性。 方法：通過回顧性分析2009年3月至2013年7月份的48名分別在TACE術(shù)前、術(shù)后1個(gè)月、術(shù)后6個(gè)月行中磁共振掃描的原發(fā)性肝癌患者的71個(gè)目標(biāo)病灶（病灶面積范圍：1~25mm2）。按照實(shí)體瘤療效評(píng)價(jià)標(biāo)準(zhǔn)（Response Evaluation Criteria in Solid Tumors，RECIST）或修訂后的RECIST標(biāo)準(zhǔn)分類對TACE術(shù)后6個(gè)月的原發(fā)性肝癌病灶治療療效進(jìn)行評(píng)估、分類，同時(shí)分析TACE術(shù)前及術(shù)后1個(gè)月目標(biāo)病灶面積最大層面上ADC值及VE值的變化程度，并分析治療療效同ADC值及VE值變化的相關(guān)性，并建立ADC值及VE值的變化程度的受試者工作特性曲線（receiver operating characteristic，ROC）評(píng)價(jià)其分類病灶療效的準(zhǔn)確性。 結(jié)果：按照RECIST標(biāo)準(zhǔn)，TACE術(shù)后6個(gè)月的71個(gè)目標(biāo)病灶評(píng)估為30個(gè)部分緩解病灶（partial response，PR），35個(gè)穩(wěn)定病灶（stable disease，SD），6個(gè)進(jìn)展病灶（progressive disease，PD）。與TACE術(shù)前MR比較，71個(gè)目標(biāo)病灶TACE術(shù)后1個(gè)月ADC值均增加和VE值均下降并且具有統(tǒng)計(jì)學(xué)意義。ADC增加和VE下降的程度在PR、SD、PD存在組間差異。以ADC值增加的百分?jǐn)?shù)為參數(shù)繪制PR組和（SD組+PD組）的ROC曲線圖，其ROC曲線下面積（underthe ROC curve，AUC）為0.78，臨界值是51.3%，此時(shí)的靈敏度為70%，特異度為73.2%；以ADC值增加的百分?jǐn)?shù)為參數(shù)繪制（PR組+SD組）和PD組的ROC曲線，其AUC為0.89，臨界值是29.3%，此時(shí)的靈敏度為83%，特異度為100%。以VE值下降的百分?jǐn)?shù)為參數(shù)繪制PR組和（SD組+PD組）的ROC曲線圖，其AUC為0.73，臨界值為51.9，此時(shí)的靈敏度為51.9%，特異度為63.4%；以VE值下降的百分?jǐn)?shù)為參數(shù)繪制（PR組+SD組）和PD組的ROC曲線，其AUC為0.90，臨界值是26.8%，此時(shí)的靈敏度為86.2%，特異度為100%。 結(jié)論：TACE術(shù)后1個(gè)月的病灶A(yù)DC值的增加程度和VE值的下降程度可以預(yù)測的TACE遠(yuǎn)期療效。多模態(tài)MR數(shù)據(jù)分析可以作為HCC患者TACE治療后遠(yuǎn)期療效評(píng)估的生物標(biāo)志。
[Abstract]:Objective : To explore the correlation between apparent diffusion coefficient ( ADC ) and portal venous phase enhanced signal intensity ( VE ) in patients with primary hepatocellular carcinoma ( HCC ) after transcatheter arterial chemotherapy ( TACE ) for 1 month after TACE .

Methods : Seventy - eight primary liver cancer patients ( 1 - 25 mm2 ) were analyzed retrospectively for the primary liver cancer patients who underwent magnetic resonance imaging before TACE , 1 month after TACE and 6 months after TACE . To evaluate the efficacy of response Evaluation Criteria in Solid Tumors ( RECIST ) or revised RECIST criteria for the treatment of primary liver cancer lesions for 6 months after TACE , and to analyze the correlation between ADC values and VE values at the largest level of target lesion area before and after TACE , and to analyze the correlation between the therapeutic efficacy and ADC value and VE value , and to establish the receiver operating characteristic ( ROC ) of ADC values and VE values to evaluate the accuracy of its classified lesions .

Results : According to RECIST criteria , 71 target lesions were assessed as 30 partial response ( PR ) , 35 stable disease ( SD ) and 6 progressive disease ( PD ) in 30 partial response lesions in 6 months after TACE . Compared with the pre - TACE MR , the ADC value increased and the value of VE decreased and the value of VE decreased after TACE in 71 target lesions . The ROC curve of PR group and ( SD group + PD group ) was plotted with the increase of ADC value . The ROC curve under ROC curve was 0.78 , the critical value was 51.3 % , the sensitivity was 70 % and the specificity was 73.2 % .
The ROC curves of PR group + SD group and PD group were plotted as the percentage of ADC value . The AUC was 0.89 , the critical value was 29 . 3 % , the sensitivity was 83 % and the specificity was 100 % . The ROC curve of PR group and ( SD group + PD group ) was plotted as the percentage of VE value . The AUC was 0.73 , the critical value was 51.9 , the sensitivity was 51.9 % and the specificity was 63.4 % .
The percentage of VE value decreased as parameter ( PR group + SD group ) and ROC curve of PD group . The AUC was 0.90 and the critical value was 26 . 8 % . At this time , the sensitivity was 86.2 % and the specificity was 100 % .

Conclusion : The increase of ADC value and the decrease of VE value can be predicted by TACE in 1 month after TACE . Multi - modal MR data analysis can be used as biomarker of long - term efficacy assessment after TACE in HCC patients .
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R735.7;R445.2

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本文編號(hào)：1952438