2011-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/645728摘要：肝細胞癌為國人十大癌症。目前肝動脈化學栓塞術是無法接收治癒性治療的肝癌患者的第一線選擇。載藥微珠是一種新的藥物傳遞系統，可搭載doxorubicin用來進行肝動脈栓塞治療，與傳統肝動脈化學栓塞術比較，可提供病患更長的存活期。磁振造影影像除了可用來評估腫瘤的位置和大小之外，新的3T磁振造影儀器更包含許多功能性影像和分子影像，包括動態顯影磁振造影影像(dynamic contrast-enhancedmagnetic resonance imaging)，分子擴散影像 (diffusion-weighted imaging)，和磁振造影頻譜分析術(magnetic resonance spectroscopy)。動態顯影磁振造影影像利用注射磁振造影顯影劑後腫瘤的顯影模式，來得知腫瘤的血流和滲透性參數，來早期評估治療效果及預後。分子擴散影像偵測人體組織內水分子的移動，可用來區分正常和腫瘤組織。磁振造影頻譜分析術可分析腫瘤組織內的化學物的含量。目前已有研究利用這些先進影像技術，來早期評估接受傳統肝動脈化學栓塞術治療後的效果。我們的研究以隨機分派的方式，在50位接受傳統肝動脈化學栓塞和50位接受遞西微珠栓塞術的肝癌病患，利用最新的3T磁振造影儀器，結合功能性影像和分子影像技術，偵測其治療前後腫瘤內的血流、水分子移動和化學成分的變化，並分析兩組肝腫瘤在治療後的特性和復發模式是否不同，來早期評估治療效果，並預測腫瘤復發率和病患存活預後。<br> Abstract: Hepatocellular carcinoma (HCC) is the most common malignant tumor of the liver and isalso one of the most common tumors in the world. Transarterial chemoembolization (TACE)is a treatment option for unresectable hepatocellular carcinoma and provides substantialsurvival benefits.A novel drug delivery system— DC Bead, is developed to optimize TACE effect and hasshown promising results. This new TACE technique provides higher rates of completeresponse, objective response, and disease control compared with the conventional TACE. DCBead TACE was also associated with improved tolerability, with a significant reduction inserious liver toxicity and a significantly lower rate of doxorubicin-related side effects.Currently, there is no absolutely reliable imaging method for monitoring the earlyresponse to TACE or DCB TACE Therefore, several advanced techniques with magneticresonance imaging (MRI) are actively explored to early evaluate tumor response and predictprognosis after TACE.Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) is a non-invasivequantitative technique for assessing micro-vascular structure by tracking thepharmacokinetics of injected low-molecular weight contrast agents as they pass through thetumor vasculature. This modality is being increasingly used in many oncological studies tocharacterize tumor angiogenesis and invasiveness, and monitor the treatment response.Diffusion-weighted imaging (DWI) enables qualitative and quantitative assessment oftissue diffusivity (apparent diffusion coefficient, ADC) without the use of gadoliniumchelates. DWI has been suggested to be useful in monitoring the response of HCC afterTACE because of earlier assessment of tumor necrosis with increasing ADC values.MR spectroscopy facilitates the study of cellular metabolism and in vivo detection ofabnormalities. A few studies of in vivo MR spectroscopy reported an increase in cholinelevels within tumors such as HCC and a reduction in the lipid-to-choline ratio afterconventional TACE was performed for HCC.Because these advanced MR techniques provide qualitative and quantitative informationof tumor characteristics and can be easily incorporated to existing protocols, we hypothesisthat it might be helpful to combine DCE-MRI, DWI, and MR spectroscopy for assessment oftumor response after conventional and DC Bead TACE and predict patients’ prognosis.This study is a prospective two-arm randomized clinical study using DCE-MRI, DWIand MR spectroscopy in 3T scanner to evaluate tumors in patients with unresectable HCCafter conventional TACE or DC Bead TACE. Each arm of 50 patients will be recruited fortotal 100 subjects. MRI will be performed before TACE (day 0), day 14, and day 28 to assessthe tumor responses. After day 28, all subjects will receive standard clinical care and befollowed up for at least one year. The imaging parameters will be compared among eachMRI and correlate with patients’ outcome.肝細胞癌遞西微珠肝動脈化學栓塞術動態顯影磁振造影影像分子擴散影像hepatocellular carcinomaDC BeadDynamic contrast-enhanced magnetic resonance imaging (DCE-MRI)Diffusion-weighted imaging (DWI)