肝细胞癌介入治疗后经增强CT和MRI影像诊断的对比分析  

A comparative analysis on enhanced CT and MRI scanning after interventional therapy for hepatocellular carcinoma

作　　者：罗超[1] 闵德庆[1] 胡达海 张圆[1] 习华 LUO Chao;MIN De-qing;HU Da-hai(Department of Medical Imaging,Danjiangkou First Hospital,Danjiangkou Hubei 442700,China)

机构地区：[1]丹江口市第一医院医学影像科,湖北丹江口442700 [2]丹江口市第一医院心血管内科,湖北丹江口442700

出　　处：《临床和实验医学杂志》2019年第20期2222-2224,共3页Journal of Clinical and Experimental Medicine

基　　金：2016十堰市科学技术研究项目(编号:16Y93)

摘　　要：目的分别采用增强CT与MRI扫描检查,评估肝细胞癌(HCC)患者经介入治疗后的疗效,比较两种影像学检查手段的诊断价值。方法选取2012年1月至2016年12月于丹江口市第一医院接受经导管肝动脉化学栓塞(TACE)治疗的123例中晚期结节型HCC患者的临床资料进行回顾性分析。治疗后患者分别经增强CT扫描、增强MRI扫描检查。比较两种方法诊断HCC的准确性和敏感度。结果123例患者(164个病灶)成功完成TACE治疗。治疗后第12个月临床随访结果发现,72例(81个病灶)肿瘤病灶有复发或转移,占58.54%。存活肿瘤组织在增强CT扫描下表现为动脉期强化,而静脉期及延迟期对比剂则表现快速洗脱的低密度图像。而MRI扫描不受碘油沉积等因素的影响,故比CT扫描能更精确地显示TACE治疗后病灶及其血供的情况。增强CT扫描的ROC面积为0.784±0.069,增强MRI扫描为0.993±0.012(95%CI:0.653~0.974);增强CT扫描的诊断敏感度为40.65%(50/123),增强MRI扫描的诊断敏感度为89.43%(110/123);增强MRI扫描的诊断的准确性和敏感性均高于增强CT扫描(P<0.05)。结论增强MRI扫描可弥补CT扫描的不足,推荐其作为HCC患者介入治疗后首选的随诊检查的影像学方法。Objective To evaluate the diagnostic significance of CT and MRI enhanced scanning on the efficacy of interventional therapy for hepatocellular carcinoma(HCC).Methods The clinical data of 123 patients with advanced nodular HCC treated by transcatheter arterial chemoembolization(TACE)during January 2012 to December 2016 in Danjiangkou First Hospital were retrospectively analyzed.After treatment,these patients were examined by enhanced CT scanning and enhanced MRI scanning espectively.Results 123 patients(164 lesions)successfully completed TACE treatment The follow-up results of twelve months after treatment showed that 72 cases(81 lesions)had recurrence or metastasis(58.54%).The survival tumor tissue showed enhanced arterial phase under enhanced CT scanning,while the low-density images were rapidly evoluted in venous phase and delayed phase contrast agent.MRI scanning is not affected by the deposition of lipidol and so on.Therefore,it is more accurate than CT scanning in showing the lesion and blood supply after TACE treatment.The area under the enhanced CT scanning was(0.784±0.069),the enhanced MRI scanning was(0.993±0.012)(95%CI:0.653-0.974),the diagnostic sensitivity of the enhanced CT scanning was 40.65%(50/123),and the enhanced MRI scanning was 89.43%(110/123),and the diagnostic accuracy and sensitivity of the enhanced MRI scanning were higher than those of the enhanced CT scanning(P<0.05).Conclusion The imaging evaluation of HCC patients after TACE treatment by enhanced MRI scanning can make up for the deficiency of CT scanning,and recommend it as the first choice of imaging method after interventional therapy for patients with HCC.

关 键 词：肝细胞肝癌 介入治疗 计算机体层成像核磁共振成像 经导管肝动脉化学栓塞 

分 类 号：R73[医药卫生—肿瘤]