影像学检查在肝癌外科术后甲胎蛋白阴性患者随访中的价值  

The clinical value of imaging examination in following up postoperative AFP-negative patients after surgery for hepatocellular carcinoma

作　　者：高杨[1,2] 纪建松[1,2] 杨宏远[1,2] 王祖飞[1,2] 杨伟斌[1,2] 赵中伟[1,2] 卢陈英[1,2] 吴徐璐 

机构地区：[1]浙江大学丽水医院放射科,浙江丽水323000 [2]温州医科大学附属第五医院放射科

出　　处：《介入放射学杂志》2016年第4期355-359,共5页Journal of Interventional Radiology

基　　金：浙江省重大科技专项计划项目(2013C03010);浙江省丽水市科技计划项目(2013ZC026)

摘　　要：目的探讨超声（US）、CT及MRI和DSA等影像检查在甲胎蛋白（AFP）阴性肝癌患者外科术后随访中的价值,旨在提高肝癌外科术后AFP阴性患者早期复发及转移的诊断准确率,也有助于介入术后复发、转移的诊断。方法回顾性分析2008年1月—2013年12月31例经病理或临床治疗证实的肝癌外科术后AFP正常患者复发和或转移的随访资料。结果在随访过程中,31例患者均行US、CT、MRI和数字减影血管造影（DSA）检查,共发现肝内复发转移灶55个。US检出35个（63.6%）,CT检出45个（81.8%）,MRI检出53个（96.4%）;US、CT、MRI三者联合,检出54个（98.2%）。小于1 cm复发或转移灶共20个,MRI检出率显著高于CT及US,同期检出率分别为18/20（90.0%）、13/20（65.0%）、7/20（35.0%）;直径在1~2 cm复发或转移灶共24个,MRI、CT及US同期检出率分别为24/24（100%）、21/24（87.5%）、19/24（79.2%）;大于2 cm的复发或转移灶共11个,MRI、CT及US同期检出率分别11/11（100%）,11/11（100%）,9/11（81.8%）。结论 MRI检出肝癌外科术后AFP阴性患者复发及转移较超声、CT有明显优势。联合应用US、CT及MRI的综合筛查模式在肝癌外科术后AFP阴性患者的随访中具有重要的临床价值。亦可以此指导介入术后患者的随访复查。Objective To discuss the clinical application of ultrasound（US）, computed tomography（CT）, magnetic resonance imaging（MRI）, DSA and other imaging equipments in following up postoperative hepatocellular carcinoma patients with negative alpha-fetoprotein test so as to improve the diagnostic accuracy of early recurrence and metastasis in AFP-negative patients after surgery for liver cancer. Methods The clinical follow-up data of 31 AFP-negative patients with pathologically or clinically confirmed postoperative recurrence or metastasis of liver cancer, who were admitted to authors＇ hospital during the period from January 2008 to December 2013, were retrospectively analyzed. Results During the follow-up period, all patients underwent US, CT, MRI and DSA examinations. A total of 55 hepatic metastatic lesions were found.The metastatic lesions were detected by US（n=35, 63.6%）, CT（n=45, 81.8%） and MRI（n=53, 96.4%）.US together with CT and MRI revealed 54 metastatic lesions in total（98.2%）. Twenty recurrence or metastasis lesions were less than 1 cm in diameter. The detection rate of MRI was significantly higher than that of CT and US, the detection rates in the same period being 90.0%（18/20）, 65.0%（13/20） and 35.0%（7/20）respectively. Twenty-four recurrence or metastasis lesions were 1-2 cm in diameter; the detection rates in the same period by MRI, CT and US were 100%（24/24）, 87.5%（21/24） and 79.2%（19/24） respectively. Eleven recurrence or metastasis lesions were〉2 cm in diameter; the detection rates in the same period by MRI, CT and US were 100%（11/11）, 100%（11/11） and 81.8%（9/11） respectively. Conclusion MRI is obviously superior to US and CT in detecting early recurrence and metastasis in AFP-negative patients after surgery for liver cancer. The combination use of US, CT and MRI, as a comprehensive screening mode, has very important clinical value in following up AFP-negative HCC patients after surgery.

关 键 词：肝细胞癌 甲胎蛋白 超声 螺旋CT 磁共振成像 诊断 

分 类 号：R735.7[医药卫生—肿瘤]