基于CT和MRI的多模式影像学检查在多中心性肝细胞癌术前精准诊断中的应用价值  

Application value of multi-mode imaging examination based on CT and MRI in accurate diagnosis of multinodular and multicentric hepatocellular carcinoma before resection

作　　者：陈春妙 陈炜越 杨伟斌[1] 林桂涵 叶卫川 卢陈英[1] 胡祥华[1] 纪建松[1] CHEN Chunmiao;CHEN Weiyue;YANG Weibin;LIN Guihan;YE Weichuan;LU Chenying;HU Xianghua;JI Jiansong(Key Laboratory of Imaging Diagnosis and Minimally Invasive Intervention Research,Department of Radiology,Lishui Central Hospital,Lishui 323000,China)

机构地区：[1]丽水市中心医院浙江省影像诊断与介入微创研究重点实验室放射科,浙江丽水323000

出　　处：《温州医科大学学报》2020年第7期563-567,共5页Journal of Wenzhou Medical University

基　　金：丽水市高层次人才培养项目(2016RC22);浙江省公益技术研究计划社会发展项目(LGF19H180009)。

摘　　要：目的:探索CT联合MRI在多中心性肝细胞肝癌术前精准诊断中的应用价值。方法:回顾性分析2014年5月至2018年4月在丽水市中心医院就诊的经临床诊断为肝细胞肝癌患者42例,所有患者均接受外科手术治疗,并在术前1个月内行CT和(或)MRI扫描检查证实为多结节性病变,且所有结节均在术后经病理诊断是否为肝细胞肝癌,比较单独CT检查、单独MRI检查以及两者联合检查对肝脏结节的诊断效果。结果:纳入的42例患者,男31例,女11例,年龄(56.0±10.4)岁。经病理诊断共检出110个病灶,其中肝癌病灶76个。单独CT和单独MRI分别检出89个(占80.90%)和106个(占96.36%)病灶,其中肝癌病灶分别为64个(占84.21%)和75个(占98.68%)。联合检查共检出108个病灶(占98.18%),肝癌病灶76个全部检出。联合检查的肝癌检出率高于单独CT和单独MRI(P<0.001),且不同的检查方法对病灶的检出灵敏度、特异度、准确性、阳性预测值和阴性预测值均与病灶直径相关,直径越大,各项指标均越高。当病灶直径大于2 cm时,CT增强和MRI增强检查诊断肝癌病灶的准确度与病理检查一致。结论:CT和MRI联合检查对肝癌病灶和小病灶的检出率和准确度均优于单独检查,对于多中心性肝癌术前的精准诊断具有较高的临床应用价值。Objective:To explore the application value of CT combined with MRI in accurate diagnosis of clinical multinodular and multicentric hepatocellular carcinoma before resection.Methods:A total of 42 patients with clinically diagnosed hepatocellular carcinoma in Lishui Central Hospital from May 2014 to April 2018 were collected and analyzed retrospectively.All patients underwent surgical resection and were confirmed as multinodular lesions by CT and/or MRI scan within one month before resection,and all nodules were pathologically diagnosed as hepatocellular carcinoma after resection.The diagnostic effects of CT,MRI and CT combined with MRI in the diagnosis of hepatic nodules were then compared.Results:Of 42 patients were included in the study 31 males and 11 females,with an average age of 56.0±10.4 years,110 lesions were detected by pathological diagnosis,including 76 lesions of hepatocellular carcinoma.89 lesions were detected by CT alone(80.90%)and 106 lesions by MRI alone(96.36%),of which 64 lesions(84.21%)and 75 lesions(98.68%)were hepatocellular carcinoma(84.21%,98.68%).A total of 108 lesions were detected by combined examination(98.18%),and all 76 lesions of hepatocellular carcinoma were detected.According to the analysis,the detection rate of hepatocellular carcinoma lesions examined by combined examination was higher than by CT alone or MRI alone(P<0.001).The sensitivity,specificity,accuracy,positive predictive value and negative predictive value of different examination methods were all correlated with the diameter of the tumor,the larger,the higher all the indicators.When the diameter was larger than 2 cm,the diagnostic accuracy of CT or MRI alone was consistent with that of pathological examination of liver cancer lesions.Conclusion:CT combined with MRI is better than single examination in the detection rate and diagnostic accuracy of hepatocellular carcinoma lesions and small lesions,and therefore has good clinical application value in the accurate diagnosis of multinodular and multicentric hepatocellular

关 键 词：多中心性肝细胞肝癌 体层摄影术 X线计算机 磁共振成像 多模式检查 

分 类 号：R445.2[医药卫生—影像医学与核医学] R445.3[医药卫生—诊断学]