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目的探讨多b值扩散加权成像(DWI)在肝脏转移瘤化疗早期疗效评价中的应用价值。方法选择肝转移瘤患者19例33个病灶,在治疗前后分别行多b值的DWI扫描,分别拟合出各类表观扩散系数图(ADC10b图、ADC3b图、ADClow图、ADChigh图)并获得相应的ADC值。ADClow图与ADChigh图减影后得ADCperf图,获得ADCperf值;并以实体瘤疗效评价标准(RECIST)评价化疗疗效,比较治疗前后ADC值变化。结果治疗后8例15个肝转移病灶对化疗有效,11例18个肝转移病灶对化疗无效。治疗有效组在化疗前ADC值(ADC10b、ADC3b、ADChigh及ADClow)低于化疗无效组,而ADCperf值高于无效组,差异均有统计学意义(P<0.05)。化疗有效组化疗后ADC值(ADC10b、ADC3b、ADChigh及ADClow)均有明显增高,ADCperf值减低,治疗前后差异有统计学意义(P<0.05)。而化疗无效组的ADC值无明显变化(P>0.05)。结论多b值DWI作为一种无创性MRI功能成像技术可以对肝转移瘤化疗疗效作出早期评估,能协助临床制定个体化方案。
Objective To investigate the value of multi-b diffusion weighted imaging (DWI) in the early evaluation of the efficacy of chemotherapy for liver metastases. Methods Totally 19 lesions of hepatic metastases were selected. DWI scans of multiple b values were performed before and after treatment, and various apparent diffusion coefficient maps (ADC10b, ADC3b, ADClow and ADChigh) were obtained and obtained The corresponding ADC value. The ADCperf plot was obtained by subtracting the ADClow and ADChigh images to get ADCperf value. The curative effect of chemotherapy was evaluated by RECIST, and the changes of ADC value before and after treatment were compared. Results After treatment, 8 cases of 15 liver metastases were effective for chemotherapy and 11 of 18 liver metastases were ineffective for chemotherapy. The ADC values (ADC10b, ADC3b, ADChigh and ADClow) in the effective group before chemotherapy were lower than those in the chemotherapy ineffective group, while the ADCperf values were higher than those in the ineffective group (P <0.05). After chemotherapy, the ADC values (ADC10b, ADC3b, ADChigh and ADClow) of chemotherapy-effective chemotherapy group were significantly increased, ADCperf value was decreased, the difference was statistically significant before and after treatment (P <0.05). However, there was no significant change in the ADC value of the chemotherapy-ineffective group (P> 0.05). Conclusions Multi-b value DWI, as a noninvasive MRI functional imaging technique, can make an early assessment of the efficacy of chemotherapy for liver metastases and can assist in the development of individualized clinical programs.