弥散加权成像联合动态增强MRI预测肝细胞癌经TACE联合射频消融治疗后复发

目的 观察弥散加权成像（DWI）联合动态增强MRI预测肝细胞癌（HCC）经TACE联合射频消融治疗后复发的价值。方法 回顾性分析80例接受TACE联合射频消融治疗的HCC患者，均于治疗前10天和治疗后20、60及90天接受腹部DWI及动态增强MR检查；计算DWI联合动态增强MRI预测TACE联合射频消融治疗后20天HCC复发的敏感度、特异度及准确率；绘制受试者工作特征（ROC）曲线，评估以表观弥散系数（ADC）值预测TACE联合射频消融治疗后20天HCC复发的效能。结果 参照改良实体瘤疗效评价标准，将47例HCC患者纳入稳定组、33例归为进展组。TACE联合射频消融治疗后20天，稳定组HCC病灶DWI多呈不均匀信号、ADC图呈高信号、增强扫描未见强化，进展组病灶多呈DWI高信号、ADC图低信号、增强扫描轻度强化。DWI联合动态增强MRI预测TACE联合射频消融治疗后20天HCC复发的敏感度、特异度及准确率分别为97.75%（87/89）、92.31%（24/26）及96.52%（111/115）。以ADC值预测TACE联合射频消融治疗后20天HCC复发的曲线下面积为0.82；以ADC=1.42×10^-3 mm²/s为截断值，预测的敏感度及特异度分别为72.13%及82.25%。结论 DWI联合动态增强MRI用于预测TACE联合射频消融治疗后HCC复发具有一定价值；ADC值可作为有效预测指标。

Combination of diffusion weighted imaging and dynamic contrast-enhanced MRI for predicting recurrence of hepatocellular carcinoma after TACE combined with radiofrequency ablation

Objective To explore the value of combination of diffusion weighted imaging (DWI) and dynamic contrast-enhanced MRI (DCE-MRI) for predicting recurrence of hepatocellular carcinoma (HCC) after TACE combined with radiofrequency ablation. Methods Date of 80 HCC patients who underwent TACE combined with radiofrequency ablation were retrospectively analyzed. Abdominal DWI and DCE-MRI were performed 10 days before as well as 20, 60 and 90 days after treatment. The sensitivity, specificity and accuracy of combination of DWI and DCE-MRI for predicting recurrence of HCC 20 days after TACE combined with radiofrequency ablation were calculated, and receiver operating characteristic (ROC) curve was drawn to evaluate the efficacy of apparent diffusion coefficient (ADC) value for predicting recurrence of HCC 20 days after treatment. Results Patients with HCC were divided into stable group (n=47) and progressive group (n=33) according to modified response evaluation criteria in solid tumors. Twenty days after TACE combined with radiofrequency ablation, most HCC lesions in stable group presented as uneven DWI signals and high ADC signals without enhancement, while those in progressive group mainly presented as high DWI signals and low ADC signals with mild enhancement. The sensitivity, specificity and accuracy of combination of DWI and DCE-MRI for predicting recurrence of HCC 20 days after TACE combined with radiofrequency ablation was 97.75% (87/89), 92.31% (24/26) and 96.52% (111/115), respectively, and the AUC of ADC value was 0.82. Taken 1.42×10^-3 mm²/s as the cutoff value of ADC, the sensitivity and specificity of ADC value for predicting recurrence of HCC 20 days after TACE combined with radiofrequency ablation was 72.13% and 82.25%, respectively. Conclusion Combination of DWI and DCE-MRI had certain value for predicting recurrence of HCC after TACE combined with radiofrequency ablation, and ADC could be used as an effective predicting index.