摘要
目的比较磁共振扩散加权成像(MR-DWI)不同弥散敏感梯度(b)值下表观扩散系数(ADC)值对肝细胞癌(HCC)患者经导管动脉化疗栓塞(TACE)治疗后疾病进展的评估价值。方法回顾性分析武警特色医学中心符合病例纳入和排除标准的初次接受TACE治疗的168例HCC患者的临床病理资料,根据TACE治疗后第6个月时的MRI检查评估治疗效果的结果将患者分为稳定组和进展组,比较2组患者TACE治疗前的临床和影像学资料,使用Cox风险比例回归模型分析可能导致TACE治疗后疾病进展的因素,使用受试者操作特征曲线分析不同b值下ADC值预测判断患者TACE治疗后的效能。结果与稳定组患者比较,进展组患者在TACE治疗前有乙肝肝硬变病史、门静脉癌栓及动静脉瘘比例更高且BCLC分期和Child Pugh分级均更差(P<0.05),进展组患者在不同b值下的ADC值均明显高于稳定组(P<0.05);进一步的多因素分析结果发现,TACE治疗前b=600和800 s/mm^2时的ADC值、伴乙肝肝硬变病史、门静脉癌栓、动静脉瘘以及BCLC分期和Child Pugh分级是TACE治疗后第6个月时疾病进展的危险因素。当b值为800 s/mm^2时的ADC值预测患者TACE治疗结局的效能最高,其受试者操作特征曲线下面积为0.746,当ADC值最佳诊断截点为1.20×10^–3 mm^2/s时的敏感度为73.3%、特异度为71.8%。结论MR-DWI的ADC值可较好地预测HCC患者TACE治疗疾病进展情况,b值为800 s/mm^2时的ADC值对HCC患者TACE治疗后的预后具有较高预测价值。
Objective To compare the value of apparent diffusion coefficients(ADCs)of MR-DWI at different b values in evaluating the progression of hepatocellular carcinoma(HCC)after transcatheter arterial chemoembolization(TACE).Methods All of 168 patients with HCC who met the inclusion and exclusion criteria and received the TACE for the first time in the Characteristic Medical Center of PAPF were collected retrospectively,who were divided into a stable group and progressive group according to the results of MRI evaluation at the 6th month after the TACE treatment.The clinical and imaging data of the two groups were compared before the TACE treatment.The Cox proportional hazard regression model was used to analyze the risk factors for the disease progression after the TACE treatment.The receiver operating characteristic curve(ROC)was used to analyze the predicting of efficacy evaluation of TACE by the ADC values at different b values.Results Compared with the stable group,the proportions of hepatitis B cirrhosis history,portal vein tumor thrombus,and arteriovenous fistula were higher(P<0.05),and the BCLC stage and Child Pugh grade were worse(P<0.05),and the ADC values were higher(P<0.05)in the progressive group.The results of Cox analysis showed that the ADC values at b=600 and 800 s/mm^2 before the TACE,history of hepatitis B cirrhosis,portal vein tumor thrombus,arteriovenous fistula,advanced BCLC stage and Child-Pugh grade were the risk factors for the progression at the 6th month after the TACE treatment.When the b value was 800 s/mm2,the ADC value had the highest efficacy in predicting the outcome of patients(area under ROC curve was 0.746),and the best diagnostic cut-off point was 1.20×10^–3 mm^2/s,the sensitivity was 73.3%and the specificity was 71.8%.Conclusion ADC value of MR-DWI could predict progression after TACE in patients with HCC,and ADC value of 800 s/mm^2 has a better predictive value for them.
作者
王晶
张泉
谷鹏
袁飞
WANG Jing;ZHANG Quan;GU Peng;YUAN Fei(Department of Outpatient,Characteristic Medical Center of PAPF,Tianjin 300162,P.R.China;Department of Medical Imaging,Characteristic Medical Center of PAPF,Tianjin 300162,P.R.China)
出处
《中国普外基础与临床杂志》
CAS
2020年第10期1236-1240,共5页
Chinese Journal of Bases and Clinics In General Surgery
基金
天津市科技计划项目(项目编号:15ZXLCSY00040)。
关键词
肝细胞癌
磁共振成像
经导管动脉化疗栓塞
表观扩散系数
hepatocellular carcinoma
magnetic resonance imaging
transcatheter arterial chemoembolization
apparent diffusion coefficient
