多模式影像对复发性肝癌的诊断价值研究  

Study on the diagnostic value with multi-mode imaging of recurrent hepatocellular carcinoma

作　　者：李立[1] 吴晶涛[2] 刘丽[1] 陈新国[1] 吴正宇[1] 

机构地区：[1]江苏省靖江市人民医院医学影像科,214500 [2]江苏省苏北人民医院医学影像科,214500

出　　处：《实用医学影像杂志》2017年第1期12-16,共5页Journal of Practical Medical Imaging

摘　　要：目的探讨多模式影像技术磁共振成像(MRI)、数字减影血管造影(DSA)和碘油CT对复发性肝癌的检出能力。方法 50例肝癌切除术后确诊肝癌复发者(男46例,女4例,年龄27~81岁,中位年龄48.7岁),均作MRI、DSA和碘油CT,分别由2位专家(主任医师)独立判读MRI、DSA、碘化油CT全部影像资料。分析3种影像方法对不同大小病灶检出的灵敏度;根据病灶直径大小分为3组:A组,直径<5 mm;B组,直径5~30mm;C组,直径>30 mm;统计分析上述3种方法对不同大小病灶的检出率。结果 50例患者共检出239个病灶,其中MRI、DSA及碘油CT分别检出病灶154个、196个及226个,漏诊病灶分别为85个、43个及13个,灵敏度分别为64.4%、82.0%及94.6%,差异有统计学意义(P<0.05)。直径<5 mm病灶,MRI检出率50.9%(89/175),DSA检出率77.1%(135/175),碘油CT检出率96.6%(169/175);组间差异有统计学意义(P<0.05)。直径5~30 mm病灶,MRI、DSA及碘油CT检出率分别为98.0%(51/52)、90.4%(47/52)及90.4%(47/52)(P>0.05);直径>30 mm病灶,MRI、DSA及碘油CT检出率分别为100%(12/12)、83.3%(10/12)及75.0%(9/12),差异无统计学意义(P>0.05)。结论碘油CT诊断肝癌复发灵敏度最高,尤其对于微小病灶(直径<5 mm)检出率高;DSA次之;MRI对中大病灶检出率高,微小病灶检出需与其他方法联合使用以免漏诊。Objective To compare the efficacy of diagnosing recurrent hepatocellular carcinoma（HCC） with multimodal imaging techniques including MRI, digital subtract angiography（DSA）, and lipiodol-CT. Methods Total of 50 cases with recurrent HCC after resection（the group consisted of 46 men and 4 women, whose age ranged from27 to 81 year and the median age is 48.7 year）were performed with MRI,DSA and lipiodol-CT. Two experts（chief physician） evaluated all imaging data independently. The sensitivity of three imaging methods was analyzed for the different size of lesions. Recurrent lesions were divided into three groups according to the lesion size： Group A（with diameter 5 mm）, Group B（5-30 mm） and Group C（30 mm）,then detection rate of different size of recurrent HCC was evaluated respectively. Results Two hundred and thirty-nine lesions were found in 50 cases. MRI, DSA and lipidol-CT detected 154, 196 and 226 lesions respectively with 85,43 and 13 lost, and their sensitivity was 64.4 %,82.0% and 94.6% respectively（P〈0.05）. The detection rate of MRI, DSA and lipiodol-CT was 50.9%（89/175）, 77.1%（135/175） and 96.6%（169/175） respectively in Group A（P〈0.05）; 98.0%（51/52）, 90.4%（47/52） and 90.4%（47/52） in Group B（P〈0.05）; 100%（12/12）, 83.3%（10/12）and 75.0%（9/12）in Group C, there were no statistically significant（P〉0.05）. Conclusion Lipiodol CT has highest sensitivity in detection of recurrent HCC,especially for small tumor（〈5mm）. The second is DSA. The detection rate of MRI is high for large lesions which needs a combination of other imaging methods to reduce omission diagnostic rate for small recurrent foci.

关 键 词：癌 肝细胞 复发 磁共振成像 数字减影血管造影 碘油CT 

分 类 号：R735.7[医药卫生—肿瘤]