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目的探索磁共振扩散加权成像表观扩散系数(ADC值)对经导管肝动脉灌注化疗栓塞术(TACE)治疗肝癌疗效的预测价值。方法前瞻性收集2014年5月至2015年5月期间在笔者所在医院科室行第1次TACE的12例原发性肝癌患者(共计23个病灶),比较TACE前后的肿瘤直径、肿瘤ADC值和肝实质ADC值,并分析TACE前的肿瘤ADC值对疗效的预测价值。结果与TACE前比较,TACE后肿瘤直径和肝实质ADC值的差异均无统计学意义(P=0.635,P=0.473),但TACE后的肿瘤ADC值升高(P=0.003)。TACE后有17个病灶(73.9%)的坏死范围≥50%(疗效较好组),6个病灶(26.1%)的坏死范围<50%(疗效较差组)。与疗效较差组比较,TACE前后疗效较好组的肿瘤ADC值均较高(P<0.050)。肝癌病灶行TACE前的肿瘤ADC值预测TACE近期疗效的曲线下面积(AUC值)为0.690(95%CI:0.510~0.879),灵敏度为82.3%(95%CI:65.5%~93.2%),特异度为53.8%(95%CI:25.1%~80.8%),疗效好坏的截点为1.24×103 mm2/s。结论 TACE前肝癌病灶的ADC值可以在一定程度上预测TACE治疗肝癌的近期疗效。
Objective To explore the predictive value of apparent diffusion coefficient (ADC) of magnetic resonance diffusion-weighted imaging in the treatment of hepatocellular carcinoma by transcatheter arterial chemoembolization (TACE). Methods We prospectively collected 12 patients with primary hepatocellular carcinoma (23 lesions in total) in the first TACE from May 2014 to May 2015 in our hospital department. Tumor diameter before and after TACE, ADC value and Liver parenchymal ADC value, and analysis of TACE pre-tumor ADC value of the predictive value of the curative effect. Results There was no significant difference in ADC value between TACE and TACE (P = 0.635, P = 0.473), but the ADC value after TACE was increased (P = 0.003). Seventeen lesions (73.9%) had a necrosis range of ≥50% (better effect group) after TACE, and <50% (less effective group) of six lesions (26.1%). Compared with poor efficacy group, ADC values of tumors with good curative effect before and after TACE were higher (P <0.050). The area under the curve (AUC) for predicting the short-term effect of TACE on TCC pre-TACE lesions was 0.690 (95% CI: 0.510-0.879) with a sensitivity of 82.3% (95% CI: 65.5% -93.2%) The degree of 53.8% (95% CI: 25.1% ~ 80.8%), the effect of good and bad cut-off point was 1.24 × 103 mm2 / s. Conclusion The ADC value of pre-TACE hepatocellular carcinoma can predict the short-term curative effect of TACE on hepatocellular carcinoma to a certain extent.