MRI弥散加权成像结合双源CT对原发性肝癌患者TACE术后疗效的评估价值

摘要/Abstract

摘要： 目的分析磁共振成像弥散加权成像(MRI-DWI)结合双源CT对原发性肝癌患者经导管动脉化疗栓塞(TACE)术后疗效的评估价值。方法选择2022年6月至2024年12月成都市第三人民医院收治的原发性肝癌患者117例。采用MRI-DWI与双源CT检测表观弥散系数(ADC)、开始时间(TTS)、肝动脉灌注量(ALP)、血容量(RV)、肝灌注指数(HPI)与门静脉灌注量(PVP)。以受试者工作特征曲线下面积(AUROC)评估双源CT灌注成像参数联合CT对TACE术后病灶残余区的预测价值。结果术前,46例出现不均匀高灌注,71例ALP均匀灌注。PVP呈低灌注。术后1个月,85例ALP呈高灌注,病灶内部可见局部缺损或碘油沉积表现;32例ALP呈无灌注,病灶内灌注液均匀沉积。术后1个月,病灶残余区ADC值、PVP分别为(1.3±0.1)×10^-3 mm²/s、(8.0±1.6)mL/(100 mL·min^-1),显著低于术前的(1.5±0.2)×10^-3 mm²/s、(10.2±2.6)mL/(100 mL·min^-1),而ALP、HPI分别为(48.3±6.8)mL/(100 mL·min^-1)、(82.3±6.5)%,显著高于术前的(37.4±5.9)mL/(100 mL·min^-1)、(74.1±5.8)%,差异均有统计学意义(P<0.05)。术后1个月,完全栓塞区ADC值、TTS、PVP分别为(1.8±0.4)×10^-3 mm²/s、(12.1±2.9)s、(46.3±5.9)mL/(100 mL·min^-1),显著高于术前的(1.5±0.2)×10^-3 mm²/s、(6.2±1.4)s、(10.3±2.7)mL/(100 mL·min^-1),而ALP、RV、HPI分别为(16.3±3.2)mL/(100 mL·min^-1)、(4.9±1.5)mL/100 mL、(20.3±3.1)%,显著低于术前的(37.9±5.4)mL/(100 mL·min^-1)、(12.3±2.7)mL/100 mL、(73.6±5.3)%,差异均有统计学意义(P<0.05)。ROC分析得出,多参数联合预测TACE术后病灶残余区的特异度为93.8%,灵敏度为90.6%,AUC为0.909。结论 ADC值、PVP、ALP联合HPI在预测原发性肝癌患者TACE术后疗效中具有重要价值。

关键词: 磁共振成像, 弥散加权成像, 双源CT, 原发性肝癌, 经导管动脉化疗栓塞术, 疗效, 预测价值

Abstract: Objective To evaluate the efficacy of magnetic resonance imaging (MRI) with diffusion-weighted imaging (DWI) combined with dual-source CT in patients with primary liver cancer after transcatheter arterial chemoembolization (TACE). Methods A total of 117 patients with primary liver cancer (PLC) admitted to our hospital between June 2022 and December 2024 were selected. The apparent diffusion coefficient (ADC), start time (TTS), hepatic artery perfusion volume (ALP), blood volume (RV), hepatic perfusion index (HPI) and portal vein perfusion volume (PVP) were detected by MRI-DWI and dual-source CT. Receiver operating characteristic (ROC) curve was plotted, and the area under the curve (AUC) was used to evaluate the value of dual-source CT perfusion imaging parameters combined with CT in predicting residual lesion area after TACE. Results Before operation, 46 cases had non-uniform hyperperfusion and 71 cases had uniform ALP perfusion. PVP showed low perfusion. One month after operation, the results showed that 85 cases of ALP showed high perfusion, site defect or iodol deposition in the lesion. 32 cases of ALP showed no perfusion and intrafocal perfusion fluid was uniformly deposited. One month after surgery, ADC value and PVP in residual lesion were (1.3±0.1) ×10^-3 mm²/s and (8.0±1.6) [mL/ (100 mL·min^-1)], respectively, significantly lower than the values before operation [(1.5±0.2) ×10^-3 mm²/s, (10.2±2.6) [mL/ (100mL·min^-1)], P<0.05]. ALP and HPI were (48.3±6.8) [mL/ (100 mL·min^-1)] and (82.3±6.5) %, respectively, which was significantly higher than that those before operation [(37.4±5.9) [mL/ (100 mL·min^-1)] and (74.1±5.8) %, respectively, P<0.05]. One month after surgery, ADC, TTS and PVP in the completely embolized zone were (1.8±0.4) ×10^-3 mm²/s, (12.1±2.9) s, (46.3±5.9) [mL/ (100 mL·min^-1)], respectively, significantly higher than preoperative values of (1.5±0.2) ×10^-3 mm²/s, (6.2±1.4) s, (10.3±2.7) [mL/ (100 mL·min^-1) (P<0.05). ALP, RV and HPI were (16.3±3.2) [mL/ (100 mL·min^-1)], (4.9±1.5) mL/100 mL, (20.3±3.1) %, respectively, which was significantly lower than that before operation [(37.9±5.4) [mL/ (100 mL·min^-1)], (12.3±2.7) mL/100 mL, (73.6±5.3) %, P<0.05]. ROC analysis showed that the specificity and sensitivity of residual area after TACE were 93.8%, 90.6% and 0.909 respectively. Conclusion ADC value, PVP and ALP combined with HPI have important value in predicting the postoperative efficacy of TACE in patients with primary liver cancer.

Key words: Magnetic resonance imaging, Diffusion-weighted imaging, Dual-source CT, Primary liver cancer, Transcatheter arterial chemoembolization, Curative effect, Predictive value

王婉婷, 罗微. MRI弥散加权成像结合双源CT对原发性肝癌患者TACE术后疗效的评估价值[J]. 肝脏, 2026, 31(2): 207-210.

WANG Wan-ting, LUO Wei. Value of diffusion-weighted MRI combined with dual-source CT in evaluating the efficacy of TACE in patients with primary liver cancer[J]. Chinese Hepatolgy, 2026, 31(2): 207-210.

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