三维适形放疗治疗原发性肝癌患者放射性肝损伤增强MRI表现特征分析*

doi:10.3969/j.issn.1672-5069.2026.02.034

摘要/Abstract

摘要： 目的分析总结三维适形放疗(3D-CRT)治疗原发性肝癌(PLC)患者放射性肝损伤(RILI)增强磁共振成像(MRI)表现特征。方法 2023年1月～2025年9月我院诊断的PLC患者92例,均接受3D-CRT治疗,并接受钆喷酸葡胺(Gd-DTPA)MRI增强扫描,记录信号、增强模式、分布特征、扩散加权成像(DWI)和表观弥散系数(ADC)参数。结果在治疗结束后,本组发生RILI者22例(23.9%);RILI组肿瘤体检、放疗剂量、放疗靶区体积和肝剂量均显著大于非RILI组(P<0.05);RILI组病灶T1WI低信号、T2WI高信号、动脉期异常强化、门脉期强化减弱和延迟期持续低强化占比分别为77.3%、86.4%、81.8%、72.7%和68.2%,均显著大于非RILI组的27.1%、30.0%、20.0%、25.7%和17.1%(P<0.05);肝实质楔形分布、强化区与放疗剂量区一致、沿肝段或血管走行分布和DWI高信号占比分别为86.4%、90.9%、68.2%和81.8%,均显著大于非RILI组的15.7%、12.9%、14.3%和28.6%(P<0.05);RILI组ADC值为(1.5±0.2)×10^-3mm²/s,显著大于非RILI组【(1.2±0.2)×10^-3mm²/s,P<0.05】。结论 RILI患者肝内病灶增强MRI表现具有一定的特征,可帮助医生结合临床资料诊断和处理。

关键词: 原发性肝癌, 三维适形放疗, 放射性肝损伤, 增强磁共振成像, 特征

Abstract: Objective This study aimed to investigate and summarize magnetic resonance imaging (MRI) feature in patients with primary liver cancer (PLC) and radiation-induced liver injury RILI) after three-dimensional conformal radiotherapy (3D-CRT). Methods A total of 92 patients with PLC were encountered in our hospital between January 2023 and September 2025, and all received 3D-CRT therapy and underwent gadopentetate dimeglumine (Gd-DTPA)-enhanced MRI scan. MRI signal, dynamic contrast-enhancement patterns, distribution morphology, diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) values were recorded. Results By end of radiotherapy, RILI occurred in 22 cases (23.9%); tumor volume, doses of radiation, target volume and mean hepatic doses of radiation in patients with RILI were all greater than in those without RILI(P<0.05); percentages of hypointensity on T1-weighted imaging, hyperintensity on T2-weighted imaging, abnormal enhancement at arterial phase, decreased enhancement at portal venous phase and persistent hypointensity at delayed phase in lesions in patients with RILI were 77.3%, 86.4%, 81.8%, 72.7% and 68.2%, all significantly greater than 27.1%, 30.0%, 20.0%, 25.7% and 17.1%(P<0.05) in those without RILI; percentages of wedge-shaped distribution, insistency of enhanced area with radiotherapy dose distribution, distributed along hepatic segments or vascular courses and hyperintensity on DWI in patients with RILI were 86.4%, 90.9%, 68.2% and 81.8%, all much greater than 15.7%, 12.9%, 14.3% and 28.6%(P<0.05) in those without RILI; ADC value in patients with RILI was (1.5±0.2)×10^-3mm²/s, much greater than [(1.2±0.2)×10^-3mm²/s, P<0.05] in those without RILI. Conclusion Patients with PLC and RILI could have special MRI features, which might help clinicians make diagnosis and managements.

Key words: Hepatoma, Three-dimensional conformal radiotherapy, Radiation-induced liver injury, Enhanced MRI scan, Feature

蔡蓉蕾, 廖荣信, 罗伟, 唐良俊. 三维适形放疗治疗原发性肝癌患者放射性肝损伤增强MRI表现特征分析^*[J]. 实用肝脏病杂志, 2026, 29(2): 297-300.

Cai Ronglei, Liao Rongxin, Luo Wei, et al. MRI feature in patients with primary liver cancer and radiation-induced liver injury after three-dimensional conformal radiotherapy[J]. Journal of Practical Hepatology, 2026, 29(2): 297-300.

参考文献

[1] Chen W, Chiang CL, Dawson LA. Efficacy and safety of radiotherapy for primary liver cancer. Chin Clin Oncol, 2021, 10(1):9.
[2] Dawson LA, Ringash J, Fairchild A, et al. Palliative radiotherapy versus best supportive care in patients with painful hepatic cancer (CCTG HE1): a multicentre, open-label, randomised, controlled, phase 3 study. Lancet Oncol, 2024, 25(10):1337-1346.
[3] Lee VH, Vardhanabhuti V, Wong TC, et al. Stereotactic body radiotherapy and liver transplant for liver cancer: A nonrandomized controlled trial. JAMA Netw Open, 2024, 7(6):e2415998.
[4] Asagi A, Sakaguchi C, Nadano S, et al. Efficacy and safety of three-dimensional conformal radiotherapy for macroscopic vascular invasion of hepatocellular carcinoma. Acta Med Okayama, 2022, 76(6):679-688.
[5] Racka I, Majewska K, Winiecki J. Three-dimensional conformal radiotherapy (3D-CRT) vs. volumetric modulated arc therapy (VMAT) in deep inspiration breath-hold (DIBH) technique in left-sided breast cancer patients-comparative analysis of dose distribution and estimation of projected secondary cancer risk. Strahlenther Onkol, 2023, 199(1):90-101.
[6] 张丹, 孙静, 王佳, 等. 原发性肝细胞癌患者立体定向放射治疗所致的放射性肝损伤影响因素分析. 中华肝脏病杂志, 2021, 29(6):575-579.
[7] Prayongrat A, Srimaneekarn N, Sriswasdi S, et al. Assessment of the confidence interval in the multivariable normal tissue complication probability model for predicting radiation-induced liver disease in primary liver cancer. J Radiat Res, 2021, 62(3): 483-493.
[8] Ding Z, Wu Y, Fang G, et al. Development and validation a radiomics nomogram for predicting thymidylate synthase status in hepatocellular carcinoma based on Gd-DTPA contrast enhanced MRI. BMC Cancer, 2023, 23(1):991.
[9] Rata M, Castagnoli F, Shur J, et al. Qualitative and quantitative assessment of accelerated liver diffusion-weighted imaging using deep-learning reconstruction in oncologic patients. BMC Med Imaging, 2025, 25(1):491.
[10] Yoon J, Lee Y, Yoon S, et al. Deep learning reconstruction of free-breathing, diffusion-weighted imaging of the liver: A comparison with conventional free-breathing acquisition. PLoS One, 2025, 20(5):e0320362.
[11] 中华人民共和国国家卫生健康委员会医政司.原发性肝癌诊疗指南(2024年版).中华肝脏病杂志,2024,32(7):581-630.
[12] 包天舒, 杜野牧, 姚善文, 等. 三维适形放疗治疗PLC患者疗效及发生放射性肝损伤影响因素分析. 实用肝脏病杂志, 2024,27(1):105-108.
[13] Kim J, Jung Y. Radiation-induced liver disease: current understanding and future perspectives. Exp Mol Med, 2017, 49(7):e359.
[14] Li L, Wu Q, Lin Z, et al. Single-cell transcriptome sequencing reveals hepatocyte heterogeneity in response to radiation-induced liver injury and regeneration. Radiother Oncol, 2026, 214:111225.
[15] Wang Z, Wu T, Wang H, et al. THBS1 as a candidate biomarker and fibrotic mediator in radiation-induced liver injury: insights from TMT-labeled quantitative proteomics. Front Pharmacol, 2025, 16:1659870.
[16] Sun J, Lu HR, Wu JH, et al. Radiation-induced liver injury: Anoverview. J Hepatocell Carcinoma, 2025, 12:2045-2054.
[17] Zhou YL, Wang ZX, Gao JQ, et al. Tmprss6 modulates radiation-induced liver injury through the hepcidin axis and PI3K/AKT pathway. Int J Radiat Biol, 2025, 101(8):860-875.
[18] Wijnen N, Bruijnen RCG, Thelissen AAB, et al. Ablation of small liver metastases presenting as foci of diffusion restriction on MRI-results from the prospective minimally invasive thermal ablation (MITA) study. Cancers (Basel), 2024, 16(13):2409.
[19] Zeng H, Shi G, Mai S, et al. Imaging and clinical features of colorectal liver metastases with macroscopic intrabiliary growth. Eur J Radiol, 2021, 137:109616.
[20] Zhu HB, Xu D, Sun XF, et al. Prediction of hepatic lymph node metastases based on magnetic resonance imaging before and after preoperative chemotherapy in patients with colorectal liver metastases underwent surgical resection. Cancer Imaging, 2023, 23(1):18.

三维适形放疗治疗原发性肝癌患者放射性肝损伤增强MRI表现特征分析^*

MRI feature in patients with primary liver cancer and radiation-induced liver injury after three-dimensional conformal radiotherapy

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]	严云, 张玉霞, 王雪婷, 唐晨湘. 非酒精性脂肪性肝病合并药物性肝损伤患者临床特征分析^*[J]. 实用肝脏病杂志, 2026, 29(2): 213-216.
[2]	严鑫路, 张利华, 王韦韦, 武丽, 陈勇. 抗肿瘤药物致药物性肝损伤患者临床特征及其临床转归研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 229-232.
[3]	蒋楠, 刘泉, 郝福荣. 免疫联合SBRT治疗中晚期原发性肝癌患者疗效与安全性分析^*[J]. 实用肝脏病杂志, 2026, 29(2): 285-288.
[4]	孙志青, 赵彦娜, 贺祥昆, 葛晨. 损伤控制性手术原则治疗原发性肝癌自发性破裂大出血患者止血效果研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 293-296.
[5]	石国富, 朱志韬, 张苏波, 金怀玉. MSCT联合增强MRI鉴别诊断肝脏局灶性结节性增生与肝细胞癌价值研究^*[J]. 实用肝脏病杂志, 2026, 29(2): 301-304.
[6]	丁靖诺, 赵卫峰, 赵法之. 急性门静脉血栓形成诊治经验分享:15例病例报道与文献复习[J]. 实用肝脏病杂志, 2026, 29(1): 113-116.
[7]	王威, 孟云, 冀鹏. 磁共振成像鉴别诊断肝硬化背景下不典型增生结节与小肝癌临床价值研究^*[J]. 实用肝脏病杂志, 2026, 29(1): 133-136.
[8]	邱瑶雪, 孙银春, 陈诚, 秦雅群, 许淑君, 查翔远. 90例细菌性肝脓肿患者临床特征及抗菌药物应用分析^*[J]. 实用肝脏病杂志, 2026, 29(1): 137-140.
[9]	李建林, 李娅, 郑秋然, 王燕. ¹²⁵I放射性粒子植入联合TACE治疗原发性肝癌患者疗效研究^*[J]. 实用肝脏病杂志, 2025, 28(6): 894-897.
[10]	田潭平, 杨定华, 宋新, 周旅, 周国超, 付华, 蔡融民, 彭鹏. TACE联合免疫和靶向综合治疗中晚期原发性肝癌患者临床效果研究^*[J]. 实用肝脏病杂志, 2025, 28(6): 898-901.
[11]	何倩, 张瑞, 史莉玲, 张莹. 超声特征联合血清ROMO1和AFP诊断儿童肝母细胞瘤价值研究^*[J]. 实用肝脏病杂志, 2025, 28(6): 918-921.
[12]	张倩, 丁蓉, 姬文莉. 122例肝脓肿患者临床特征和病原菌分析^*[J]. 实用肝脏病杂志, 2025, 28(6): 922-925.
[13]	张领, 徐明雷. 胆总管囊肿儿童磁共振胆胰管成像和多层螺旋CT表现特征分析^*[J]. 实用肝脏病杂志, 2025, 28(6): 946-949.
[14]	刘家阳, 鲁俊, 李良. 自身免疫性胰腺炎合并IgG4相关硬化性胆管炎患者临床特征分析^*[J]. 实用肝脏病杂志, 2025, 28(5): 719-722.
[15]	张小昭, 雷凯, 祁亚斌, 金雷, 朱代华. 阿替利珠单抗联合靶向药物和TACE术治疗中晚期原发性肝癌患者疗效研究^*[J]. 实用肝脏病杂志, 2025, 28(5): 759-762.