功能磁共振在肝癌TACE術(shù)后療效定量評價中的應(yīng)用研究
發(fā)布時間：2018-11-14 17:23
【摘要】：目的： 1.評估不同感興趣區(qū)設(shè)置方法對肝癌患者肝動脈化療栓塞（TACE）術(shù)治療前后ADC值測量及觀察者之間變異的影響。 2.探討磁共振擴散加權(quán)成像在肝癌TACE術(shù)后療效監(jiān)測中的應(yīng)用價值。 3.研究3.0T MR動態(tài)增強掃描定量參數(shù)在TACE術(shù)后療效評估中的應(yīng)用價值。 方法: 1.36例經(jīng)病理、臨床及影像學(xué)證實中晚期肝癌患者于TACE術(shù)前、術(shù)后1個月行擴散加權(quán)成像檢查(b=0，1000)。兩位有經(jīng)驗的放射科醫(yī)生分別采用整體容積法、最大層面法、多個小樣本法三種不同ROI設(shè)置方法對肝癌病灶行ADC值測量。對不同ROI設(shè)置方法測量的平均ADC±SD值及觀察者之間變異的差異用組內(nèi)相關(guān)系數(shù)（ICC）進行對比分析。 2.32例經(jīng)病理、臨床及影像學(xué)證實的中晚期肝癌患者于TACE術(shù)前、術(shù)后1個月行擴散加權(quán)成像及動態(tài)增強掃描檢查，通過測量TACE術(shù)前、術(shù)后腫瘤的大小、正常肝臟組織和腫瘤的ADC值及兩者差值，觀察TACE術(shù)后腫瘤表觀彌散系數(shù)值的變化趨勢及肝癌壞死情況，評價TACE術(shù)后一月的動態(tài)增強掃描強化早期病灶液化壞死范圍，并以腫瘤壞死≥50%為標準將病灶分為有效組及無效組，判斷TACE術(shù)治療后腫瘤復(fù)發(fā)或殘存情況，并預(yù)測患者遠期生存情況。 3.用3.0T磁共振對經(jīng)病理、臨床及影像學(xué)證實的24例肝癌患者分別于TACE術(shù)前一周內(nèi)，術(shù)后1個月及3個月分別進行動態(tài)增強掃描，影像學(xué)測量腫瘤橫軸位最長徑，以及肝癌TACE術(shù)前、后動態(tài)增強掃描定量參數(shù)：Ktrans，Kep，ve，進行單因素方差分析，P0.05為結(jié)果有統(tǒng)計學(xué)意義。 結(jié)果: 1.三種ROI設(shè)置方法在不同觀察者間均存在較好的一致性(P0.05,ICC=0.99)。整體容積法ROI的ICC在TACE術(shù)前非常好（0.91），在TACE術(shù)后良好（0.79），單層最大層面法在TACE術(shù)前、術(shù)后的ICC分別為0.77和0.63，多個小樣本法的ICC分別為0.76和0.37。多個小樣本法TACE術(shù)前ADC值低于整體容積法或最大層面法。TACE術(shù)后的ADC值在整體容積、最大層面或多個小樣本ROI間差異無統(tǒng)計學(xué)意義。整體容積和最大層面ROI的SD顯著大于多個小樣本ROI。 2.對比肝癌TACE術(shù)前、術(shù)后腫瘤的ADC值變化，術(shù)后一個月ADC值普遍升高，無效組術(shù)前ADC值低于有效組，有效組術(shù)后ADC值高于無效組，無效組術(shù)前、術(shù)后ADC值變化不大，有效組治療前、后ADC值變化顯著。術(shù)前、術(shù)后ADC（%）值越大，，治療效果越好，兩者之間存在統(tǒng)計學(xué)差異；TACE術(shù)前、術(shù)后腫瘤大小及其周圍正常肝臟組織ADC值變化均無統(tǒng)計學(xué)差異。 3.（1）以RECIST為標準，將治療結(jié)果分為有效組18個，無效組6個。（2）以RECIST標準為參考時，治療前無效組與有效組間Ktrans值差異具有統(tǒng)計學(xué)意義。（3）在肝癌TACE術(shù)后，RECIST評估標準中的有效組與無效組間Ktrans值、Kep值在治療前與第1個月后復(fù)查、治療前與第3個月后復(fù)查變化差異均有統(tǒng)計學(xué)意義。結(jié)論: 1. ROI設(shè)置大小和位置對腫瘤的ADC值測量和觀察者間變異有一定的影響。肝癌TACE術(shù)后觀察者間變異性較大。整體容積法獲得的腫瘤ADC值最具可重復(fù)性。 2. DWI作為無創(chuàng)、無輻射性檢查方法，可以更好的用于預(yù)測評估肝癌TACE術(shù)后療效。 3.以RECIST標準評估療效時，治療前Ktrans值具有預(yù)測作用，磁共振動態(tài)增強掃描可用于肝癌TACE術(shù)后療效評估，其參數(shù)Ktrans、Kep可定量評估療效。
[Abstract]:Purpose: 1. To evaluate the change between the ADC value and the observer before and after the treatment of hepatic artery chemoembolization (TACE) in patients with liver cancer with different region of interest setting method The effect of magnetic resonance diffusion weighted imaging in the treatment of hepatocellular carcinoma after TACE Application value of 3. 0T MR dynamic enhanced scan quantitative parameters in TACE In the assessment The application value of the method was 1. 36 cases of advanced liver cancer were confirmed by pathology, clinical and imaging, and the diffusion weighting was performed for 1 month after the operation of TACE. Imaging examination (b = 0,1000). Two experienced radiologists use the overall volume method, the maximum level method, the multiple small sample methods, and the three different ROI settings Methods The ADC value of the liver cancer was measured. The mean ADC value and the difference of the variation between the observer and the observer were measured in different ROI setting methods. The relationship number (ICC) was compared and analyzed. 2. 32 patients with advanced liver cancer confirmed by pathology, clinical and imaging were examined by diffusion-weighted imaging and dynamic enhanced scan before and after TACE, and the size of the tumor after TACE was measured before and after TACE. The value of the ADC and the difference of the two values of the liver tissue and the tumor were observed. The trend of the numerical value of the apparent diffusion coefficient of the tumor after TACE and the condition of the necrosis of the liver cancer were observed. 0% of the lesions were divided into an effective group and an invalid group, and the tumor recurrence after the treatment of TACE was judged. or the survival of the patients, and the long-term survival of the patients was predicted. 3. 24 cases of liver cancer, which were confirmed by pathology, clinical and imaging, were respectively and dynamically enhanced in the first one week and the third month after the operation of the TACE in the 3. 0T magnetic resonance imaging. The longest diameter of the transverse axis of the tumor and the quantitative parameters of the dynamic enhanced scan before and after the operation of the TACE of the liver cancer: Ktrans, Kep, ve, and the single cause variance of prime The results are as follows: 1. Three kinds of ROI setting methods are in different observers The ICC was very good (P0.05, ICC = 0.99). The ICC of the whole volume method was very good (0.91) before TACE, and good (0.79) after TACE. The maximum level of the single layer was 0.77 and 0 before the TACE.. 63. The ICC of multiple small sample methods is 0.76 and 0.37, respectively. The pre-operative ADC value of the sample method TACE is lower than the overall volume method or the maximum level method. The ADC values after the TACE are rounded There is no statistical significance between the volume of the volume, the maximum level, or the multiple small sample ROI. The volume of the volume and the SD of the maximum level of the ROI were significantly greater than that of the multiple small samples of ROI. 2. The ADC value of the post-operative tumor changes before and after the TACE operation in the liver cancer. The ADC value was generally increased one month after the operation. The ADC value before the operation was lower than that of the effective group. The ADC value in the effective group was higher than that of the invalid group. Before operation, the greater the value of ADC (%), the better the value of the post-operative ADC, the better the value of the ADC (%) after the operation, the better the treatment effect, the difference between the two, and before the TACE, Post-op There was no statistical difference in the size of the tumor and the changes in the ADC value of the normal liver tissue around it. (1) According to RECIST as the standard, the treatment results were divided into 18 effective groups and 6 ineffective groups. (2) RECIST criteria For reference, the difference of the Ktrans values between the ineffective group and the effective group was of statistical significance. (3) The Ktrans value between the effective group and the ineffective group in the RECIST evaluation standard after the TACE of the liver cancer was the same as that of the effective group, and the Kep value was in the treatment group. Front and After 1 month, there was a significant difference in the post-treatment and 3-month post-treatment review. Conclusion: 1. ROI setting size and position versus tumor The ADC value measurement and the inter-observer variability have a certain effect. The inter-observer variability was large after TACE in liver cancer. The value of the tumor ADC obtained by the whole volume method was the most reproducible. 2. DWI was used as a non-invasive and non-radiative method, which could be used to predict the efficacy of TACE in the evaluation of liver cancer.
【學(xué)位授予單位】：第四軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R445.2;R735.7
本文編號：2331816
[Abstract]:Purpose: 1. To evaluate the change between the ADC value and the observer before and after the treatment of hepatic artery chemoembolization (TACE) in patients with liver cancer with different region of interest setting method The effect of magnetic resonance diffusion weighted imaging in the treatment of hepatocellular carcinoma after TACE Application value of 3. 0T MR dynamic enhanced scan quantitative parameters in TACE In the assessment The application value of the method was 1. 36 cases of advanced liver cancer were confirmed by pathology, clinical and imaging, and the diffusion weighting was performed for 1 month after the operation of TACE. Imaging examination (b = 0,1000). Two experienced radiologists use the overall volume method, the maximum level method, the multiple small sample methods, and the three different ROI settings Methods The ADC value of the liver cancer was measured. The mean ADC value and the difference of the variation between the observer and the observer were measured in different ROI setting methods. The relationship number (ICC) was compared and analyzed. 2. 32 patients with advanced liver cancer confirmed by pathology, clinical and imaging were examined by diffusion-weighted imaging and dynamic enhanced scan before and after TACE, and the size of the tumor after TACE was measured before and after TACE. The value of the ADC and the difference of the two values of the liver tissue and the tumor were observed. The trend of the numerical value of the apparent diffusion coefficient of the tumor after TACE and the condition of the necrosis of the liver cancer were observed. 0% of the lesions were divided into an effective group and an invalid group, and the tumor recurrence after the treatment of TACE was judged. or the survival of the patients, and the long-term survival of the patients was predicted. 3. 24 cases of liver cancer, which were confirmed by pathology, clinical and imaging, were respectively and dynamically enhanced in the first one week and the third month after the operation of the TACE in the 3. 0T magnetic resonance imaging. The longest diameter of the transverse axis of the tumor and the quantitative parameters of the dynamic enhanced scan before and after the operation of the TACE of the liver cancer: Ktrans, Kep, ve, and the single cause variance of prime The results are as follows: 1. Three kinds of ROI setting methods are in different observers The ICC was very good (P0.05, ICC = 0.99). The ICC of the whole volume method was very good (0.91) before TACE, and good (0.79) after TACE. The maximum level of the single layer was 0.77 and 0 before the TACE.. 63. The ICC of multiple small sample methods is 0.76 and 0.37, respectively. The pre-operative ADC value of the sample method TACE is lower than the overall volume method or the maximum level method. The ADC values after the TACE are rounded There is no statistical significance between the volume of the volume, the maximum level, or the multiple small sample ROI. The volume of the volume and the SD of the maximum level of the ROI were significantly greater than that of the multiple small samples of ROI. 2. The ADC value of the post-operative tumor changes before and after the TACE operation in the liver cancer. The ADC value was generally increased one month after the operation. The ADC value before the operation was lower than that of the effective group. The ADC value in the effective group was higher than that of the invalid group. Before operation, the greater the value of ADC (%), the better the value of the post-operative ADC, the better the value of the ADC (%) after the operation, the better the treatment effect, the difference between the two, and before the TACE, Post-op There was no statistical difference in the size of the tumor and the changes in the ADC value of the normal liver tissue around it. (1) According to RECIST as the standard, the treatment results were divided into 18 effective groups and 6 ineffective groups. (2) RECIST criteria For reference, the difference of the Ktrans values between the ineffective group and the effective group was of statistical significance. (3) The Ktrans value between the effective group and the ineffective group in the RECIST evaluation standard after the TACE of the liver cancer was the same as that of the effective group, and the Kep value was in the treatment group. Front and After 1 month, there was a significant difference in the post-treatment and 3-month post-treatment review. Conclusion: 1. ROI setting size and position versus tumor The ADC value measurement and the inter-observer variability have a certain effect. The inter-observer variability was large after TACE in liver cancer. The value of the tumor ADC obtained by the whole volume method was the most reproducible. 2. DWI was used as a non-invasive and non-radiative method, which could be used to predict the efficacy of TACE in the evaluation of liver cancer.
【學(xué)位授予單位】：第四軍醫(yī)大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R445.2;R735.7
【參考文獻】
相關(guān)期刊論文 前6條
1 袁友紅;肝臟磁共振擴散成像及進展[J];實用放射學(xué)雜志;2003年10期
2 尚全良;肖恩華;賀忠;譚利華;司徒衛(wèi)軍;白末了;袁術(shù)文;杜萬平;;肝癌經(jīng)導(dǎo)管動脈灌注化療栓塞術(shù)療效的MR擴散加權(quán)成像動態(tài)研究[J];中華放射學(xué)雜志;2006年03期
3 ;Computed tomography perfusion in evaluating the therapeutic effect of transarterial chemoembolization for hepatocellular carcinoma[J];World Journal of Gastroenterology;2008年37期
4 桑莉;王濱;劉峰;寧厚法;葛艷明;孫西河;董鵬;;磁共振擴散加權(quán)成像評價TACE聯(lián)合血管生成抑制劑內(nèi)皮抑素治療兔VX2肝移植瘤[J];中國醫(yī)學(xué)影像技術(shù);2009年05期
5 王東,張挽時,徐家興;MR擴散成像[J];中國醫(yī)學(xué)影像技術(shù);1999年01期
6 Ashwin Rammohan;Jeswanth Sathyanesan;Sukumar Ramaswami;Anand Lakshmanan;Perumal Senthil-Kumar;Ulagendra Perumal Srinivasan;Ravi Ramasamy;Palaniappan Ravichandran;;Embolization of liver tumors: Past, present and future[J];World Journal of Radiology;2012年09期
本文編號：2331816
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