放射性肝损伤患者肝脏磁共振扩散加权成像表现特征分析

doi:10.3969/j.issn.1672-5069.2019.03.016

实用肝脏病杂志 ›› 2019, Vol. 22 ›› Issue (3): 373-376.doi: 10.3969/j.issn.1672-5069.2019.03.016

放射性肝损伤患者肝脏磁共振扩散加权成像表现特征分析

彭新健, 肖玉辉, 许斯鼎, 石荣跃, 王耀政, 王瑜琳

363000 福建省漳州市厦门大学附属东南医院/解放军联勤保障部队第909医院医学影像科

收稿日期:2018-10-31 出版日期:2019-05-10 发布日期:2019-05-15
通讯作者: 肖玉辉,E-mail:xyhui0319@163.com
作者简介:彭新健,男,30岁,大学本科。E-mail:524715905@qq.com
基金资助:
*福建省自然科学基金资助项目（编号：2017J01164）

Diagnostic value of diffusion-weighted magnetic resonance imaging in patients with radiation-induced liver injury with underlying hepatocelullar carcinoma

Peng Xinjian, Xiao Yuhui, Xu Siding

Department of Radiology,909th Hospital,Affiliated to Xiamen University,Zhangzhou 363000,Fujian Province,China

Received:2018-10-31 Online:2019-05-10 Published:2019-05-15

摘要/Abstract

摘要： 目的探讨应用磁共振扩散加权成像（DWI）对放射性肝损伤( RILI)的诊断价值。方法 2015年1月~2017年6月我院诊治的肝细胞癌患者90例,在接受放射治疗后,经超声引导下肝穿刺组织病理学检查证实为RILI患者47例。根据组织病理学检查,发现急性RILI 14例,亚急性期17例和慢性16例。常规行MRI检查。结果放射性肝损伤患者MRI上表现为与放射治疗区域一致的斑片状异常信号区,在T1WI上呈低信号,在T2WI上呈高信号,DWI序列呈稍高信号,增强扫描呈中等水平斑片样强化;急性期RILI表观弥散系数（ADC）值为（85.32±8.41）×10^-6mm^-2/s,显著低于亚急性期的（88.44±9.32）×10^-6mm^-2/s或慢性期的（101.28±10.01）×10^-6mm^-2/s,三组间差异有统计学意义（P<0.05）。结论及时行磁共振扩散加权成像检查能够协助诊断RILI的发生,其ADC值能够在一定程度上反映RILI病理学改变,结合照射剂量和患者病情可能提高临床治疗的安全性。

关键词: 肝细胞癌, 放射性肝损伤, 磁共振成像, 弥散加权成像, 诊断

Abstract: Objectiv The aim of this study was to investigate the diagnostic value of diffusion-weighted magnetic resonance imaging in patients with radiation-induced liver injury （RILI） with underlying hepatocelullar carcinoma （HCC）. Methods 90 patients with histologically proven HCC were admitted to our hospital between January 2015 and June 2017,and RILI were confirmed by ultrasound-guided liver biopsies in 47 patients after radiotherapy. The pathological results showed the patients with acute RILI in 14,subacute in 17 and chronic in 16. All patients received MRI checked-up. Results The MRI manifestations in patients with RILI was a patchy abnormal signal area consistent with the radiation therapy,with low signal on T1WI,high signal on T2WI,slightly high signal on diffusion weighted imaging （DWI） sequence,and moderate enhancement on intensified scan;the apparent diffusion coefficient（ADC） value in patients with acute RILI was（85.32±8.41）×10^-6mm^-2/s,significantly lower than （88.44±9.32）×10^-6mm^-2/s in patients with subacute or （101.28±10.01）×10^-6mm^-2/s in patients with chronic RILI（P<0.05）. Conclusion The application of diffusion-weighted MR imaging might help diagnose patients with RILI,which will benefit the patients with HCC undergoing radiotherapy.

Key words: Hepatoma, Radiation induced liver injury, Magnetic resonance imaging, Diffusion-weighted imaging, Diagnosis

彭新健, 肖玉辉, 许斯鼎, 石荣跃, 王耀政, 王瑜琳. 放射性肝损伤患者肝脏磁共振扩散加权成像表现特征分析[J]. 实用肝脏病杂志, 2019, 22(3): 373-376.

Peng Xinjian, Xiao Yuhui, Xu Siding. Diagnostic value of diffusion-weighted magnetic resonance imaging in patients with radiation-induced liver injury with underlying hepatocelullar carcinoma[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2019, 22(3): 373-376.

参考文献

[1] 刘伟,吕国士. 放射性肝损伤的影像学研究概况. 实用放射学杂志,2010,26(8):1205-1207.
[2] Benson R,Madan R,Kilambi R,et al.Radiation induced liver disease:A clinical update. J Egyp N Ca Inst,2016,28:7-11.
[3] Huang Y,Chen SW,Fan CC,et al.Clinical parameters for predicting radiation-induced liver disease after intrahepatic reirradiation for hepatocellular carcinoma. Radiat Oncol,2016,11:89.
[4] Jung J,Yoon SM,Kim SY,et al.Radiation-induced liver disease after stereotactic body radiotherapy for small hepatocellular carcinoma:clinical and dose-volumetric parameters. Radiat Oncol,2013,8:249.
[5] Liang SX,Huang XB,Zhu XD,et al.Dosimetric predictor identification for radiation induced liver disease after hypofractionated conformal radiotherapy for primary liver carcinoma patients with Child-Pugh grade A cirrhosis. Radiat Oncol,2011,98:265-269.
[6] Lai YL,Kuo YC,Lai HC,et al.Early radiation-induced liver toxicities are associated with poor survival in patients with advanced hepatocellular carcinoma. Asia Pac J Clin Oncol,2016,12:437-443.
[7] Kim TH,Kim DY,Park JW,et al.Dose-volumetric parameter spredicting radiation-induced hepatic toxicity in unresectable hepatocellular carcinoma patients treated with three dimensionalconformal radiotherapy. Int J Radiat Oncol Biol Phys,2007,67(1):225-231.
[8] Gencel O,Naziroglu M,Celik O,et al.Selenium and vitamin emodulates radiation induced liver toxicity in pregnant and nonpregnant rat:effects of colemanite and hematite shielding. Biol Trace Elem Res,2010,135:253-263.
[9] Kim HG,Jang SS,Lee JS,et al.Meyer prevents radiation-induced liver injury via modulation of oxidative stress and apoptosis. J Ginseng Res,2017,41(2):159-168.
[10] Wu ZF,Zhang JY,Shen XY,et al.A mouse radiation-induced liver disease model for stereotactic body radiation therapy validated in patients with hepatocellular carcinoma. Med Phys,2016,43(17):4349.
[11] Stenmark MH,Cao Y,Wang H,et al.Estimating functional liver reserve following hepatic irradiation:adaptive normal tissue response models. Radiother Oncol,2014,111:418-423.
[12] Guha C,Kavanagh BD.Hepatic radiation toxicity:avoidance and amelioration. Semin Radiat Oncol,2011,21:256-263.
[13] Marks LB,Yorke ED,Jackson A,et al.Use of normal tissue complication probability models in the clinic. Int J Radiat Oncol Biol Phys,2010,76:10-19.
[14] Feng J,Chen SB,Wu SJ,et al.Quantitative analysis of contrast-enhanced ultrasonography in acute radiation-induced liver injury:An animal model. Exp Ther Med,2015,10:1807-1811.
[15] Fukugawa Y,Namimoto T,Toya R,et al.Radiation-induced liver injury after 3D-conformal radiotherapy for hepatocellular carcinoma:Quantitative assessment using Gd-EOB-DTPA-enhanced MRI. Acta Med Okayama,2017,71(1):25-29.
[16] Kobashi K,Prayongrat A,Kimoto T,et al.Assessing the uncertainty in a normal tissue complication probability difference (NTCP):radiation-induced liver disease(RILD) in liver tumour patients treated with proton vs X-ray therapy. J Radiat Res,2018,59(suppl 1):i50-i57.
[17] Gong HY,Hu WG,Hu QY,et al.Radiation-induced pulmonary injury accelerated pulmonary metastasis in a mouse model of breast cancer. Oncol Lett,2015,10:3613-3618.
[18] Chapman TR,Bowen SR,Schaub SK,et al.Toward consensus reporting of radiation-induced liver toxicity in the treatment of primary liver malignancies:Defining clinically relevant endpoints. Pract Radiat Oncol,2018,8(3):157-166.
[19] Ichikawa S,Motosugi U,Oguri M,et al.Magnetic resonance elastography for prediction of radiation-induced liver disease after stereotactic body radiation therapy. Hepatology,2017,66(2):664-665.
[20] 吕东来,陆林,卢虎生,等. 三维适形放射治疗原发性肝癌患者发生放射性肝损伤相关因素分析.实用肝脏病杂志,2017,20(1):89-92.

放射性肝损伤患者肝脏磁共振扩散加权成像表现特征分析

Diagnostic value of diffusion-weighted magnetic resonance imaging in patients with radiation-induced liver injury with underlying hepatocelullar carcinoma

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	中国研究型医院学会肝病专业委员会, 中国医师协会脂肪性肝病专家委员会. 脂肪性肝病诊疗规范化的专家建议（2019年修订版）[J]. 实用肝脏病杂志, 2019, 22(6): 787-792.
[2]	. 肝纤维化诊断及治疗共识（2019年）[J]. 实用肝脏病杂志, 2019, 22(6): 793-803.
[3]	吴海义, 陈建新. 四种诊断模型诊断乙型肝炎病毒携带者肝纤维化的效能分析^*[J]. 实用肝脏病杂志, 2019, 22(6): 832-835.
[4]	曹策, 郁义星, 王贝贝, 赵卫峰. 增强磁共振成像联合血清甲胎蛋白和脱-γ-羧基凝血酶原诊断肝细胞癌临床价值探讨[J]. 实用肝脏病杂志, 2019, 22(6): 896-899.
[5]	曾艳妮, 张灿, 毕俊英, 刘良进, 孟俊, 秦涛. MRI长时间延迟增强扫描诊断肝脏孤立性坏死性结节价值研究^*[J]. 实用肝脏病杂志, 2019, 22(6): 900-903.
[6]	邢昊, 韩骏, 杨田. 应用血清PIVKA-II诊断肝细胞癌研究进展^*[J]. 实用肝脏病杂志, 2019, 22(6): 934-937.
[7]	梁巨波, 苗琪, 马雄. 胆管细胞型胆汁淤积诊治进展[J]. 实用肝脏病杂志, 2019, 22(6): 941-943.
[8]	高伟, 侯勇. 肝脏硬度值检测诊断慢性乙型肝炎患者肝组织纤维化的效能分析*[J]. 实用肝脏病杂志, 2019, 22(5): 652-655.
[9]	黄汉军, 鲁凤荣, 张灿. 基于Exchange血流动力学模型的MRI扫描参数诊断肝硬化临床价值分析*[J]. 实用肝脏病杂志, 2019, 22(5): 696-699.
[10]	金良红, 李兴杰, 关红博, 麻少辉. 双能量CT碘定量结合动态对比增强MRI评估肝硬化患者肝脏血流动力学和肝功能临床价值研究*[J]. 实用肝脏病杂志, 2019, 22(5): 712-715.
[11]	朱俊, 丁莹, 王世清, 张野, 刘野, 刘泽刚. 围手术期应用乌司他丁治疗对肝细胞癌患者肝切除术后外周血Th22细胞百分比和血浆白细胞介素-22的影响*[J]. 实用肝脏病杂志, 2019, 22(5): 720-723.
[12]	王刚, 赵洪波, 朱亚玲, 蒋保三, 张越美, 刁勇. 基于数据库分析肝细胞癌细胞XPO5基因水平变化及其临床意义*[J]. 实用肝脏病杂志, 2019, 22(5): 724-727.
[13]	洪佳, 吴晓宁, 尤红. 胆汁淤积性肝病的规范化诊断[J]. 实用肝脏病杂志, 2019, 22(5): 758-760.
[14]	程华, 鞠辉, 宋德顺, 李伟. 慢性乙型肝炎患者血清血管生成素样蛋白2和高尔基体蛋白73水平变化及其诊断显著肝纤维化的效能分析^*[J]. 实用肝脏病杂志, 2019, 22(4): 494-497.
[15]	余英芳, 温生宝. 应用磁共振DWI单指数、双指数和拉伸指数模型参数评估慢性乙型肝炎患者肝纤维化程度效能研究^*[J]. 实用肝脏病杂志, 2019, 22(4): 502-505.