CAJ | 학술논문

目的：探讨MR背景抑制全身扩散加权成像(WB-DWI)在全身肿瘤原发灶及远处转移灶显示、疗效评估以及术后随访中的应用价值。材料与方法使用美国GE Optimal 360型1.5 T光纤MR扫描仪，信号采集使用磁体内置BODY线圈，采用反转恢复回波平面扩散序列(STIR-DWI-EPI)，对7名健康志愿者及70例临床确诊为恶性肿瘤或临床疑似肿瘤患者行WB-DWI检查，同时采集全身轴面DWI和与其同层对应的ADC图，应用AW 4.5 Functool DWI后处理软件，经三维最大密度投影重建及黑白反转后形成全身“类-PET-MRI”图像。对所有WB-DWI影像与常规MRI影像表现比较分析。结果7名健康志愿者及70例患者均获得高质量的WB-DWI图像，原发灶及转移灶在DWI图像上均呈高信号， ADC图为低信号，健康志愿者均未发现恶性病变。70例患者中，30例为新辅助治疗前或术前行WB-DWI检查明确原发灶或评价远处转移情况，其中12例检出转移灶；11例为评价新辅助治疗后局部病灶及远处转移灶疗效情况，病灶或转移灶较前缩小、增大、无明显变化例数分别为6例、3例、2例，1例甚至达到临床缓解，即在常规MRI检查及WB-DWI影像上未见异常强化灶及异常高信号影；28例为手术综合治疗后随访，其中16例未见局部复发及其他脏器转移，5例肿瘤局部复发，7例检出远处其他脏器转移；1例大量腹水查因患者经检查后发现右侧大腿肌群间异常高信号，病理证实为血管瘤。结论类-PET-MRI技术对发现全身恶性肿瘤患者的原发灶及远处转移灶非常敏感，能更早、更准确地对肿瘤的诊断、分期、预后和综合疗效评估提供指导意义。与PET-CT相比，类-PET-MRI技术无辐射、无需注射对比剂、检查方便快捷、经济，更适合于肿瘤患者治疗前后的疗效评估和随访，同时也适合健康人群肿瘤筛查。
목적：탐토MR배경억제전신확산가권성상(WB-DWI)재전신종류원발조급원처전이조현시、료효평고이급술후수방중적응용개치。재료여방법사용미국GE Optimal 360형1.5 T광섬MR소묘의，신호채집사용자체내치BODY선권，채용반전회복회파평면확산서렬(STIR-DWI-EPI)，대7명건강지원자급70례림상학진위악성종류혹림상의사종류환자행WB-DWI검사，동시채집전신축면DWI화여기동층대응적ADC도，응용AW 4.5 Functool DWI후처리연건，경삼유최대밀도투영중건급흑백반전후형성전신“류-PET-MRI”도상。대소유WB-DWI영상여상규MRI영상표현비교분석。결과7명건강지원자급70례환자균획득고질량적WB-DWI도상，원발조급전이조재DWI도상상균정고신호， ADC도위저신호，건강지원자균미발현악성병변。70례환자중，30례위신보조치료전혹술전행WB-DWI검사명학원발조혹평개원처전이정황，기중12례검출전이조；11례위평개신보조치료후국부병조급원처전이조료효정황，병조혹전이조교전축소、증대、무명현변화례수분별위6례、3례、2례，1례심지체도림상완해，즉재상규MRI검사급WB-DWI영상상미견이상강화조급이상고신호영；28례위수술종합치료후수방，기중16례미견국부복발급기타장기전이，5례종류국부복발，7례검출원처기타장기전이；1례대량복수사인환자경검사후발현우측대퇴기군간이상고신호，병리증실위혈관류。결론류-PET-MRI기술대발현전신악성종류환자적원발조급원처전이조비상민감，능경조、경준학지대종류적진단、분기、예후화종합료효평고제공지도의의。여PET-CT상비，류-PET-MRI기술무복사、무수주사대비제、검사방편쾌첩、경제，경괄합우종류환자치료전후적료효평고화수방，동시야괄합건강인군종류사사。
Objective: To investigate the clinical value of whole body diffusion-weighted imaging (WB-DWI) in discovery of malignant primary tumor and metastasis, assessment of tumor response to neoadjuvant therapy and postoperative follow-up. Materials and Methods: Fiber magnetic resonance scanner(GE Optimal 360 1.5 T, US) and short T1 inversion recovery echo-planar imaging diffusion weighted sequence (STIR-EPI-DWI) and body coil were used to obtain the WB-DWI for 7 volunteers and 70 diagnosed or suspected cancer patients. Meanwhile, all axial DWI and corresponding ADC figure with the same layer were collected. Then, the WB-DWI images were reconstructed using the three-dimensional maximum intensity projection(MIP) and inverted-gray-scale with AW 4.5 Functool DWI post processing software and images similar to PET images can be achieved. All WB-DWI images were compared with conventional MRI scanning. Results: High quality WB-DWI images were obtained for 7 volunteers and 70 patients. The primary tumor and metastatic lesions showed high signal on DWI images and low signal on ADC ifgures, and malignant lesions were not found in volunteers. Twelve cases in 30 patients who intended to assess distant metastases before therapy were detected metastases. Eleven cases in 70 patients who planned to evaluate tumor and metastases response to neoadjuvant therapy, within which 6 cases reduced in size, 1 case even achieved clinical remission, while 3 cases increased and 2 cases had no change. Twenty-eight cases conducted follow-up after comprehensive treatment, 16 cases without local recurrence and metastases, 5 with local recurrence, and 7 were found metastases. One patient with massive ascites took an examination and found abnormal high signal between right thigh muscle groups, confirmed by pathology hemangioma. Conclusions:WB-DWI can provide acceptable earlier and comparable efficacy guiding significance for tumor diagnosing, staging, and prognosing, therapeutic evaluation, which is more sensitive in detecting primary lesion and metastases. Compared with PET-CT, there is no radiation, without injection of contrast agent, and WB-DWI is more convenient and economic, so it is more suitable for cancer patients to evaluate response to neoadjuvant therapy and take long-term follow-up after operation and tumor screening of healthy crowd.