王旭丽 周志明 陈苏闽

【摘要】 目的：探讨多层螺旋CT（MSCT）结合MR弥散加权成像（DWI）对肝癌患者经导管肝动脉化疗栓塞（TACE）治疗效果的评估价值。方法：前瞻性选取海安市人民医院2018年2月—2023年2月收治的102例肝癌患者为研究对象。所有患者TACE治疗前后均行MSCT、MRI检查，分析影响肝癌患者TACE治疗效果的因素。结果：102例肝癌患者TACE治疗后3个月，完全缓解（CR）13例，部分缓解（PR）28例，疾病稳定（SD）41例，疾病进展（PD）20例，CR、PR共41例，记为客观缓解组，剩余61例记为未缓解组。治疗后，客观缓解组门静脉灌注量（PVP）、表观弥散系数（ADC）均高于未缓解组，肝动脉灌注量（HAP）、Kep均低于未缓解组（P<0.05）。以肝癌患者TACE治疗效果为应变量（客观缓解=0，未缓解=1），PVP、ADC、Kep、HAP为自变量（赋值为原始数值），进行logistic回归分析，结果显示，HAP、ADC是影响肝癌患者TACE治疗效果的因素（P<0.05）。ROC曲线结果显示，HAP、ADC及二者联合评估肝癌患者TACE治疗效果的敏感度分别为74.45%、79.63%、74.45%，特异度分别为74.38%、76.99%、89.69%，AUC分别为0.749、0.740、0.884。结论：HAP、ADC与肝癌患者TACE治疗效果有关，二者联合评估肝癌患者TACE治疗效果效能最高。

【关键词】 肝癌 多层螺旋CT MR 扩散加权成像 经导管肝动脉化疗栓塞

Evaluation Value of Multi-slice Spiral CT Combined with MR Diffusion Weighted Imaging in TACE Treatment of Patients with Liver Cancer/WANG Xuli， ZHOU Zhiming， CHEN Sumin. //Medical Innovation of China， 2024， 21（14）： -151

[Abstract] Objective： To investigate the evaluation value of multi-slice spiral CT （MSCT） combined with MR diffusion weighted imaging in transcatheter arterial chemoembolization （TACE） treatment of patients with liver cancer. Method： A total of 102 patients with liver cancer admitted to People's Hospital of Haian City from February 2018 to February 2023 were prospectively selected as the study objects. All patients were examined by MSCT and MRI before and after TACE treatment， and the factors affecting the therapeutic effect of TACE on patients with liver cancer were analyzed. Result： In 102 patients with liver cancer， 3 months after TACE treatment， 13 cases of complete remission （CR）， 28 cases of partial remission （PR）， 41 cases of stable disease （SD）， 20 cases of progression disease （PD）， 41 cases of CR and PR were recorded as objective remission group， and the remaining 61 cases were recorded as non-remission group. After treatment， protal vein perfusion （PVP） and apparent diffusion coeffecient （ADC） in objective remission group were higher than those in non-remission group， hepatic arteral perfusion （HAP） and Kep were lower than those in non-remission group （P<0.05）. logistic regression analysis was performed taking TACE treatment effect of patients with liver cancer as dependent variable （objective response=0， non-response=1）， and PVP， ADC， Kep， HAP as independent variables （valuated as original value）. The results showed that HAP and ADC were the factors affecting the therapeutic effect of TACE in patients with liver cancer （P<0.05）. ROC curve results showed that the sensitivity of HAP， ADC and their combination in evaluating the therapeutic effect of TACE in patients with liver cancer was 74.45%， 79.63%， and 74.45% respectively， the specificity was 74.38%， 76.99%， 89.69% respectively， and the AUC was 0.749， 0.740， 0.884 respectively. Conclusion： HAP and ADC are related to TACE treatment effect in patients with liver cancer， and their combination evaluation of TACE treatment effect in patients with liver cancer has the highest efficacy.

[Key words] Liver cancer Multi-slice spiral CT MR Diffusion weighted imaging Transcatheter arterial chemoembolization

First-author's address： Department of Image， People's Hospital of Haian City， Haian 226600， China

doi：10.3969/j.issn.1674-4985.2024.14.035

肝癌为临床中常见恶性肿瘤，其发病机制较为复杂，与乙/丙肝病毒感染、长期饮酒等因素有关[1-2]。肝癌目前仍是临床治疗的一大难点，经导管肝动脉化疗栓塞（TACE）是一种常用的肝癌治疗方法，可使患者获得生存受益，但效果的准确评估对于制订后续治疗方案和预测患者预后至关重要[3]。多层螺旋CT（MSCT）可以提供高分辨率的肝脏影像，并能够准确显示肿瘤的大小、位置和血供情况[4]。通过检测肿瘤的动态增强程度和血流灌注情况，MSCT能够评估TACE治疗后肿瘤的缩小程度和血供状态，帮助评估治疗的效果。而MR扩散加权成像（DWI）则可以提供有关肿瘤微观结构和细胞密度的信息，该技术基于水分子在组织中的自由扩散速度进行成像，可以评估组织的细胞排列情况[5]。在肝癌治疗过程中，肿瘤的细胞密度和组织结构可能会发生改变，因此，MR DWI可以帮助评估TACE治疗后肿瘤的细胞排列变化，进一步评估治疗的效果和判断患者的预后。……