3.0TVIBE序列动态增强磁共振检查在评估经导管肝动脉化疗栓塞术治疗肝细胞癌疗效中的价值

目的评价3.0T磁共振VIBE序列动态增强在判断肝细胞癌经导管肝动脉化疗栓塞术治疗后肿瘤坏死、残存及发现肝内新病灶的价值。方法选择48例经TACE治疗后的HCC患者,于TACE治疗后1～2个月内行MR检查,MR检查后2～5天内行DSA检查。观察动态增强扫描各时相病灶的MR征象和时间-信号强度曲线,判断原发病灶有无肿瘤残存及有无新病灶,并与DSA相对照。结果48例病例共63个原发病灶,40个病灶MR3D动态增强扫描及DSA均显示有肿瘤残存,20个病灶无肿瘤残存,诊断符合率为95.24%（60/63）。19例患者MR3D动态增强扫描及DSA均显示有新病灶,27例未发现新病灶,诊断符合率为95.83%（46/48）。3D-VIBE发现HCC病灶（包括残癌和新病灶）的敏感度为91.7%,特异度为100%,准确度为93.4%。结论3.0TMRIVIBE序列动态增强能清楚显示HCC经TACE治疗后原发病灶肿瘤残存及新病灶,并可清晰显示病灶供血动脉、引流静脉及肝血管解剖,是评估TACE治疗HCC疗效和发现新病灶的可靠方法。

Dynamic contrast-enhanced VIBE sequence at 3.0T MR: assessment of therapeutic effect of transcatheter arterial chemoembolization for hepatocellucer carcinoma

Objective To evaluate the value of dynamic contrast-enhanced volumetric interpolated breath hold examination (3D VIBE) sequence at 3.0T MR in the assessment of therapeutic effect of transcatheter arterial chemoembolization (TACE) for the treatment of hepatocellucer carcinoma (HCC). Methods Forty-eight HCC patients with 63 original focus were treated with TACE. MRI examination was performed in all patients 1-2 months after TACE. The MR appearances of the focus on the hepatic arterial, portal venous and equilibrium phase of 3D dynamic contrast-enhanced sequence and time-signal intensity curves were carefully observed and compared with DSA. Results Both 3D dynamic contrast-enhanced MRI and DSA showed 40 complete necrosis and 20 viable foci, the coincidence rate was 95.24% (60/63). New tumor foci were detected in 19 patients by both 3D dynamic MRI and DSA, with a coincidence rate of 95.83% (46/48). The sensitivity, specificity and accuracy of 3D dynamic MRI.In demonstrating the intra-hepatic foci (new foci and residual foci) were 91.7%, 100% and 93.4%, respectively. Conclusion The residual viability of original HCC and the new tumor foci can be accurately detected with 3D dynamic contrast-enhanced MR imaging at 3.0T. 3D dynamic MRI can provide detailed information about the blood-supply and dragging vein of foci. As a non-invasive technique, MRI is a good choice for the evaluation of HCC after TACE.