【摘要】：目的：探討原發(fā)性肝細(xì)胞癌射頻消融治療前后核磁共振成像的變化特點(diǎn)及應(yīng)用價(jià)值。 材料和方法：分析24例符合臨床病理標(biāo)準(zhǔn)的原發(fā)性肝細(xì)胞癌患者的MR影像資料，共25個(gè)病灶首次行射頻消融術(shù)； MRI檢查時(shí)間為射頻術(shù)前2天內(nèi)，射頻術(shù)后1個(gè)月復(fù)查；應(yīng)用Siemens Verio3.0T超導(dǎo)型磁共振掃描儀，進(jìn)行常規(guī)T1WI、T2WI、動(dòng)態(tài)增強(qiáng)以及DWI掃描；分別測(cè)定射頻消融術(shù)前以及術(shù)后活性區(qū)、病灶過(guò)渡區(qū)、正常肝臟的ADC值；使用成對(duì)樣本t檢驗(yàn)及重復(fù)測(cè)量方差分析進(jìn)行數(shù)據(jù)分析。 結(jié)果：病灶的術(shù)前T1WI表現(xiàn)為低信號(hào)；T2WI表現(xiàn)為稍高或較高信號(hào)；DWI表現(xiàn)為高信號(hào)；ADC圖像為低信號(hào)；動(dòng)態(tài)增強(qiáng)掃描表現(xiàn)為動(dòng)脈期強(qiáng)化，門(mén)靜脈期及延時(shí)期信號(hào)下降；消融術(shù)后T1WI平掃信號(hào)有不同程度增高；T2WI、DWI信號(hào)有不同程度下降；ADC圖像信號(hào)有不同程度增高；動(dòng)態(tài)增強(qiáng)掃描治療區(qū)內(nèi)部均未見(jiàn)明顯動(dòng)脈期強(qiáng)化。配對(duì)t檢驗(yàn)顯示射頻消融術(shù)后壞死灶的ADC值高于術(shù)前病灶實(shí)質(zhì)，差異具有顯著性（t=-4.049，P＜0.01）；術(shù)后治療區(qū)過(guò)渡部分的ADC值高于術(shù)前，差異具有顯著性（t=-2.217，，P＜0.05）。邊緣殘留及復(fù)發(fā)病灶與正常信號(hào)的邊緣、治療區(qū)以遠(yuǎn)肝臟組織、消融壞死灶的ADC值比較均有下降，差異具有顯著性（P＜0.05）；重復(fù)測(cè)量方差分析結(jié)果顯示：在不同個(gè)體間，治療前病灶部位的ADC值最小，為（0.86705±0.14728）×10-3mm2/s，其次為過(guò)渡部位，為（1.07806±0.23537）×10-3mm2/s，而正常肝臟部位的ADC值最大，為（1.25944±0.17809）×10-3mm2/s，三部位兩兩比較差異均有統(tǒng)計(jì)學(xué)意義（P0.05）；治療后，三部位的ADC值，依次分別為（1.18284±0.3517）×10-3mm2/s、（1.21421±0.25481）×10-3mm2/s、（1.20954±0.17337）×10-3mm2/s,ADC值雖略有差異，但差異無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）。過(guò)渡部位和病灶部位治療后的ADC值與治療前相比差異均有統(tǒng)計(jì)學(xué)意義（P0.05），而正常肝臟組織治療前后的差異則無(wú)統(tǒng)計(jì)學(xué)意義（P=0.237）。 結(jié)論：核磁共振檢查不但是原發(fā)性肝癌臨床診斷的標(biāo)準(zhǔn)之一；更可以作為射頻消融治療后療效評(píng)價(jià)的手段。
[Abstract]:Objective: to investigate the characteristics and application value of nuclear magnetic resonance imaging (MRI) before and after radiofrequency ablation of primary hepatocellular carcinoma (HCC). Materials and methods: the MR data of 24 patients with primary hepatocellular carcinoma according to clinicopathological criteria were analyzed, 25 lesions were treated with radiofrequency ablation for the first time, MRI was examined within 2 days before radiofrequency surgery and 1 month after radiofrequency surgery, and conventional T1WI, T2WI, dynamic enhancement and DWI scan were performed with Siemens Verio3.0T superconducting magnetic resonance scanner. The ADC values of active area, lesion transition area and normal liver were measured before and after radiofrequency ablation, and the data were analyzed by pairwise sample t test and repeated measurement variance analysis. Results: the lesions showed low signal intensity before operation; T2WI showed slightly higher or higher signal intensity; DWI showed high signal intensity; ADC image showed low signal intensity; dynamic contrast-enhanced scan showed arterial phase enhancement and portal vein phase and delayed signal decrease; T1WI plain scan signal increased in varying degrees after ablation; T2WI signal decreased in varying degrees; ADC image signal increased in varying degrees. There was no obvious arterial phase enhancement in the treatment area of dynamic contrast-enhanced scanning. Pairing t test showed that the ADC value of the lesion after radiofrequency ablation was significantly higher than that before operation (t 鈮

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