Progress in the evaluation of IVIM-DWI after hepatocellular carcinoma treated by transcatheter arterial chemoembolization or radiofrequency ablation
-
摘要: 晚期肝癌失去手术机会或者病人无法耐受手术治疗时,可采取经导管肝动脉化疗栓塞术、射频消融术等非手术治疗方法,其中经导管肝动脉化疗栓塞术和/或射频消融术是肝癌非手术治疗的主要方法。患者治疗前后准确的检查诊断、早期术后疗效评估,是肝癌患者术后最大获益的关键。现已有不同的疗效评估方法,基本都是形态学上的评估,其可靠性及准确性不够。而目前认为反映组织微观变化的多b值体素内不相干运动扩散加权成像(IVIM-DWI)技术,可以先于肿瘤形态学的变化反映肿瘤的残留或新生血管,可进行肿瘤治疗后早期疗效的评估,将有望提高对肝癌经经导管肝动脉化疗栓塞术和/或射频消融术治疗评价的可靠性和准确性。本文对上述内容的研究进展进行综述,目的在进一步深化临床研究对肝癌经经导管肝动脉化疗栓塞术和/或射频消融术治疗后疗效的评价,推动IVIM-DWI技术在临床实践中广泛开展。
-
关键词:
- 肝细胞肝癌 /
- 体素内不相干运动扩散加权成像 /
- 非手术治疗 /
- 评估
Abstract: In advanced hepatocellular carcinoma, non-surgical treatments such as Transcatheter Arterial Chemoembolization (TACE), radiofrequency ablation (RFA) and other non-surgical treatments may be used when there is no chance of surgery or the patient can't tolerate surgery. TACE and/or RFA are the main method of non-surgical treatments of hepatocellular carcinoma. Accurate diagnosis before or after treatments, early postoperative evaluation of the efficacy of hepatocellular carcinoma are the keys to the greatest benefit of patients after the non-surgical treatments. At present, it is considered that the multi-b value IVIM-DWI technique can not only reflects microscopic changes of tissues,but also reflects the tumor residual or neovascularization before tumor morphological changes. The multi-b value IVIM-DWI technique can evaluate the early effect of treatment for cancer. It is expected to improve the reliability and accuracy of the non-surgical treatments of hepatocellular carcinoma. The paper aims to deepen non-surgical treatment of hepatocellular carcinoma evaluation,and widely promote IVIM-DWI technology in clinical practice.-
Key words:
- hepatocellular carcinoma /
- IVIM-DWI technique /
- non-surgical treatment /
- evaluation
-
[1] 陈建国, 朱健, 张永辉, 等. 肝癌流行趋势的改变: 基于启东40年癌症登记资料的分析[J]. 中国肿瘤, 2014, 23(8): 621-8. doi: 10.11735/j.issn.1004-0242.2014.08.A001 [2] 李自慧, 陈洁, 邹岭, 等. 肝细胞肝癌合并微血管癌栓的研究进展[J]. 中华消化外科杂志, 2017, 16(1): 105-8. [3] Zhang C, Li C, Chen X, et al. Overexpression of dishevelled 2 is involved in tumor metastasis and is associated with poor prognosis in hepatocellular carcinoma[J]. Clin Transl Oncol, 2017, 19(12): 1507-17. doi: 10.1007/s12094-017-1697-z [4] 郑山, 蒲宏全, 代敏, 等. 金昌队列人群肺癌疾病负担研究[J]. 中华流行病学杂志, 2016, 37(3): 311-5. doi: 10.3760/cma.j.issn.0254-6450.2016.03.005 [5] 广东省抗癌协会肝癌专业委员会, 广东省医学会肝胆胰外科学分会. 肝细胞肝癌合并门静脉癌栓多学科团队综合治疗广东专家共识(2015版) [J]. 中华消化外科杂志, 2015, 14(9): 694-701. http://med.wanfangdata.com.cn/.../PeriodicalPaper_xhwk201509002 [6] 汪晋. 肝癌预后相关影响因素[J]. 中国普通外科杂志, 2015, 24(2): 270-4. doi: 10.3978/j.issn.1005-6947.2015.02.022 [7] 杨家进, 吴建兵. 原发性肝癌综合介入治疗进展[J]. 实用肝脏病杂志, 2015, 26(2): 118-9. https://www.wenkuxiazai.com/doc/3f791a5351e79b89680226dc.html [8] 高飞, 庞志刚, 韩斌, 等. 肝动脉化疗栓塞联合射频消融术治疗大肝癌的疗效及生存分析[J]. 介入放射学杂志, 2016, 25(4): 316-9. [9] 饶圣祥, 曾蒙苏, 陈财忠, 等. 原发性肝细胞癌射频消融治疗后MR动态随访研究[J]. 中华放射学杂志, 2010, 44(12): 1244-7. doi: 10.3760/cma.j.issn.1005-1201.2010.12.003 [10] 王莉, 赵冬梅, 韩福刚. 磁共振成像评价肝癌TACE术后疗效的应用进展[J]. 中国临床医学影像杂志, 2016, 27(2): 135-7. http://www.cqvip.com/QK/97720A/201602/667921740.html [11] Kierans AS, Elazzazi M, Braga LA, et al. Thermoablative treatments for malignant liver lesions: 10-Year experience of MRI appearances of treatment response[J]. Am J Roentgenol, 2010, 194(2): 523-9. doi: 10.2214/AJR.09.2621 [12] Hayano K, Fuentes-Orrego JM, Sahani DV. New approaches for precise response evaluation in hepatocellular carcinoma[J]. World J Gastroenterol, 2014, 20(12): 3059-68. doi: 10.3748/wjg.v20.i12.3059 [13] Chen WE, Zhuang HM, Cheng G, et al. Comparison of FDG-PET, MRI and CT for post radiofrequency ablation evaluation of hepatic tumors[J]. Ann Nucl Med, 2013, 27(1): 58-64. doi: 10.1007/s12149-012-0656-6 [14] Kim S, Mannelli L, Hajdu CH, et al. Hepatocellular carcinoma: assessment of response to transarterial chemoembolization with image subtraction[J]. J Magnetic Resonance Imag, 2010, 31(2): 348-55. doi: 10.1002/jmri.v31:2 [15] 刘长军, 费洪钧, 杨昱, 等. 多螺旋CT扫描对肝癌介入治疗效果的评价及临床应用[J]. 当代医学, 2009, 15(23): 424-5. doi: 10.3969/j.issn.1009-4393.2009.23.016 [16] 殷伟, 兰永树. 原发性肝癌射频消融术后疗效的影像学评价[J]. 中国中西医结合影像学杂志, 2015, 13(5): 568-71. http://d.wanfangdata.com.cn/Periodical/zgzxyjhyxxzz201505037 [17] 金倩娜, 杨君, 吴志强, 等. Gd-EOB-DTPA MR增强检查在肝癌TACE术后患者中的应用[J]. 实用放射学杂志, 2014, 30(5): 808-11, 821. http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_syfsxzz201405024 [18] 斯兴无, 周红俐, 陈华平, 等. MRI与CT对原发性肝癌TACE术后的疗效评估[J]. 西部医学, 2017, 29(8): 1150-3. http://www.cqvip.com/QK/95988X/201136/40444813.html [19] 孙伟, 李忱瑞. CT对肝癌TACE术后疗效及其残灶活性的评估作用分析[J]. 中国CT和MRI杂志, 2015(5): 77-9, 106. http://www.cnki.com.cn/Article/CJFDTotal-YXZD201502006.htm [20] Dromain C, de Baere T, Elias D, et al. Hepatic tumors treated with percutaneous radio-frequency ablation: CT and Mr imaging follow-up[J]. Radiology, 2002, 223(1): 255-62. doi: 10.1148/radiol.2231010780 [21] Vandecaveye V, Michielsen K, De Keyzer FA, et al. Chemoembolization for hepatocellular carcinoma: 1-Month response determined with apparent diffusion coefficient is an Independent predictor of outcome[J]. Radiology, 2014, 270(3): 747-57. doi: 10.1148/radiol.13130591 [22] Folkman J, Bach M, Rowe JW, et al. Tumor angiogenesis: therapeutic implications[J]. N Engl J Med, 1971, 285(21): 1182-6. doi: 10.1056/NEJM197111182852108 [23] 张香梅, 何明, 陈新, 等. 阿帕替尼在进展期恶性肿瘤治疗中的研究进展[J]. 广东医学, 2017, 38(z2): 168-70, 173. doi: 10.3969/j.issn.1001-9448.2017.z2.070 [24] Ng KK, Poon RT, Lo CM, et al. Analysis of recurrence pattern and its influence on survival outcome after radiofrequency ablation of hepatocellular carcinoma[J]. J Gastrointest Surg, 2008, 12(1): 183-91. doi: 10.1007/s11605-007-0276-y [25] Garrean S, Hering J, Saied A, et al. Radiofrequency ablation of primary and metastatic liver tumors: a critical review of the literature[J]. Am J Surg, 2008, 195(4): 508-20. doi: 10.1016/j.amjsurg.2007.06.024 [26] Le BD. Intravoxel incoherent motion imaging using steady-state free precession[J]. Magnet Resonance Med, 1988, 7(3): 346-9. doi: 10.1002/(ISSN)1522-2594 [27] 韦素岚, 叶枫, 余小多, 等. 体素内不相干运动DWI对肝脏良恶性病变的诊断价值[J]. 放射学实践, 2016, 31(4): 364-8. http://med.wanfangdata.com.cn/Paper/Detail/PeriodicalPaper_lcfsxzz201407012 [28] Wagner M, Doblas S, Daire JL, et al. Diffusion-weighted Mr imaging for the regional characterization of liver tumors[J]. Radiology, 2012, 264(2): 464-72. doi: 10.1148/radiol.12111530 [29] Penner AH, Sprinkart AM, Kukuk GM, et al. Intravoxel incoherent motion model-based liver lesion characterisation from three b-value diffusion-weighted MRI[J]. Eur Radiol, 2013, 23(10): 2773-83. doi: 10.1007/s00330-013-2869-z [30] Watanabe H, Kanematsu M, Goshima S, et al. Characterizing focal hepatic lesions by free-breathing intravoxel incoherent motion MRI at 3.0 T[J]. Acta radiol, 2014, 55(10): 1166-73. doi: 10.1177/0284185113514966 [31] 马霄虹, 王爽, 赵心明, 等. 体素内不相干运动扩散加权成像对肝癌经导管肝动脉化疗栓塞治疗短期疗效预测及评估价值[J]. 磁共振成像, 2017, 8(4): 248-53. http://c.wanfangdata.com.cn/periodical/zhfsx/2016-10.aspx [32] 邢春华, 陈宏伟, 崔兴宇. 腹部IVIM-DWI应用研究及进展[J]. 国际医学放射学杂志, 2015, 7(4): 335-8. http://d.wanfangdata.com.cn/Periodical_gwyx-lcfsxfc201504010.aspx
点击查看大图
计量
- 文章访问数: 560
- HTML全文浏览量: 322
- PDF下载量: 6
- 被引次数: 0