岳新建

（河南省周口市第二人民医院放射科，河南 周口 466000）



DWI对晚期肝细胞肝癌患者分子靶向药物治疗的疗效评估

岳新建

（河南省周口市第二人民医院放射科，河南 周口 466000）

目的：探讨DWI评估晚期肝细胞肝癌患者分子靶向药物治疗疗效的价值。方法：选择我院2013年1月至2014年12月收治的行分子靶向药物治疗的晚期肝细胞癌患者12例。依据治疗效果分为A组（有治疗反应组）5例和B组（无治疗反应组）7例。对2组治疗前后病灶最大径和ADC值进行观察，并进行统计学分析。结果：治疗后，A组病灶在MRI T1WI和T2WI信号增大，DWI信号无明显变化；B组病灶的T1WI、T2WI、DWI信号均无明显变化。与B组比较，A组治疗前及治疗后病灶的最大径均偏大（均P＜0.05）。A组治疗前后ADC值明显变化，而B组ADC值变化不明显（P＞0.05）。治疗前，A组病灶最大径与ADC值（b=500 s/mm2）呈正相关性（r=0.556，P=0.038）；B组病灶最大径与ADC值无明显相关性（P＞0.05）。结论：DWI可及时、准确评估晚期肝细胞肝癌分子靶向药物治疗的预后。

癌，肝细胞；分子靶向治疗；磁共振成像，弥散

［Abstract］Objective：To investigate the value of DWI in advanced hepatocellular liver cancer treated by molecule targeted drug therapy.Methods：12 cases of patients with advanced hepatocellular carcinoma treated by molecular targeted drug therapy from January 2013 to December 2014 in our hospital were selected.Based on the treatment results，patients were divided into responders group（5 cases）and non-responders（7 cases）.Before and after treatment，the lesion maximum diameter and tumor apparent diffusion coefficient（ADC value）of two groups were observed and statistically analyzed.Results：MR examination：After treatment，the T1WI and T2WI signal were increased and DWI signal had no significantly change in responders group；the T1WI，T2WI，and DWI signal had no significantly change in non-responders group.The maximum lesion diameter：before and after treatment，compared with non-responders，maximum diameter of responders group was significantly larger（P＜0.05）.There were no significantly changes of ADC values between before and after treatment in non-responders group（P＞0.05）.Before treatment，the relationship between lesions maximum diameter and ADC values（b=500 s/mm2）in responders group was positively correlated（R=0.556，P=0.038），but was no significant correlated lesions in non-responders group（P＞0.05）.Conclusion：DWI can provide unique information features for advanced HCC treated by molecular targeted drug therapy and would be a timely and accurate potential assessment tool for prognosis.

［Key words］Carcinoma，hepatocellular；Molecular targeted therapy；Diffusion magnetic resonance imaging

肝细胞肝癌（hepatocellular carcinoma，HCC）是世界第三大癌症相关死亡因素［1-2］。当前，分子靶向药物治疗受到广泛重视，但分子靶向药物不仅价格昂贵，临床治疗中还可引发一定的不良反应。因此，及时、准确的对分子靶向治疗效果进行评价具有重要意义。实体瘤的疗效评估通常使用WHO或实体肿瘤的疗效评价标准（response evaluation criteria in solid tumor，RECIST），但仅基于肿瘤形态学变化，并未考虑其他效应［3］。分子靶向药物在治疗时，肿瘤从内部坏死，而瘤体形态变化可能不明显。DWI对肝脏小转移灶的检测比T2WI敏感，其ADC值的增大与肿瘤坏死呈正相关［4-5］。……