以動態顯影磁振掃描來預測肝細胞癌對抗血管新生治療的反應

Dynamic Contrast Enhanced-Magnetic Resonance Imaging as a Prognostic Predictor of Tumor Response to Anti-Angiogenesis Therapy for the Treatment of Hepatocellular Carcinoma

施庭芳(Tiffany Ting-Fang Shih) ； 游治維(Chih-Wei Yu) ； 許昭禹(Chao-Yu Hsu) ； 陳邦斌(Bang-Bin Chen)

《中華民國癌症醫學會雜誌》 24卷5期 (2008/10) Pp. 282-288

https://doi.org/10.6588/JCOS.2008.24.5.2

摘要

大部分晚期肝細胞癌的病人只能接受全身性的治療。因為肝細胞癌是一個高血流的腫瘤，新的治療藥物多半著重在抑制腫瘤的血管新生。動態顯影磁振造影的技術，可以用來量測微血流環境與腫瘤的血管新生，有效的治療會改變動態顯影磁振造影的量化參數，進而正確並早期顯示腫瘤對抗血管新生的藥物反應。雖然動態顯影磁振造影已被廣泛運用於評估各種腫瘤的血管新生以及新藥的療效，但是在肝細胞癌病人的相關研究還很少。
大的肝細胞癌的組成相當不均勻，內部的微血流環境變化很大。動態顯影磁振造影併用藥物動力模型能夠將肝細胞癌所量測的量化參數轉換為具有高度可重複性的彩色圖形。利用這樣的圖形，我們可以圈選整個腫瘤或是腫瘤內高血流的部份來得到一個平均值，並比較治療前後這些數值的改變。我們初步的經驗顯示K(上標 trans)平均值的降低能夠預測晚期肝細胞癌病人接受治療後將會達到穩定或是惡化的狀態。但是對於動態顯影磁振造影是否真正具有預測抗血管新生藥物療效的價值，需要更多的研究與資料來佐證。

關鍵字

肝細胞癌 ； 動態顯影磁振造影 ； 血管新生

並列摘要

The majority of patients with advanced hepatocellular carcinoma (HCC) are only eligible to systemic therapies. As HCC is a hypervascular tumor, many emerging therapies act on the inhibition of angiogenesis. Dynamic contrast-enhanced MR imaging (DCE-MRI) can be used to measure microcirculation and tumor angiogenesis. Successful therapies change quantitative parameters on DCE-MRI, which may prove to be accurate and early indicators of tumor response to anti-angiogenesis agents. Although DCE-MRI is widely applied in assessing tumor response in various tumors, only few studies demonstrate its predictive value in patients with HCC.
Large HCC is biologically heterogeneous, exhibiting variation in microvasculature. DCE-MRI combined with a pharmacokinetic model allows us to produce highly reproducible parametric maps of quantitative parameters in HCC. By using pixel-by-pixel mapping, mean values of these parameters of pixels within region of interest (ROI), drawn at either whole tumor or hypervascular part, can be compared between treatment intervals. In our initial experience, reduction of mean K(superscript trans) from baseline might be able to predict tumor stability/progression in patients with advanced HCC. Further data with regard to the predictive value of DCE-MRI for assessing antiangiogenic effect in advanced HCC is warrant.

並列關鍵字

hepatocellular carcinoma HCC ； dynamic contrast-enhanced MR imaging DCE-MRI ； angiogenesis