CEUS、CE-MRI在肝细胞癌经TACE和微波消融介入治疗后随访中的应用分析  

Analysis of CEUS and CE-MRI in the follow-up of HCC after TACE and microwave ablation

作　　者：陈健 代志昌 谭书德[1] 欧龚尹 张红梅[1] CHEN Jian;DAI Zhi-chang;TAN Shu-de(Department of Radiology,Chongqing Qijiang District People's Hospital,Chongqing 401420,China)

机构地区：[1]重庆市綦江区人民医院放射科,重庆401420

出　　处：《临床和实验医学杂志》2024年第4期385-388,共4页Journal of Clinical and Experimental Medicine

基　　金：重庆市科卫联合医学科研项目(编号:2021MSXM026)。

摘　　要：目的探究对比超声造影(CEUS)、对比增强磁共振成像(CE-MRI)在肝细胞癌经动脉化疗栓塞(TACE)和微波消融介入治疗后随访中的应用。方法回顾性选取2019年8月至2022年5月在重庆市綦江区人民医院进行治疗的肝细胞癌患者102例(156个病灶),所有患者均接受TACE或微波消融介入治疗,治疗后均进行CEUS、CE-MRI检查,并以数字减影血管造影(DSA)检查结果为金标准,对复发患者和非复发患者的检查结果进行分析,探究上述两种检查方法对患者预后评估的准确性,随访期为1年。结果DSA检查结果:102例肝细胞癌患者术后1年内38例(52个病灶)患者存在复发情况,64例(104个病灶)患者未发生复发情况。复发组与未复发组患者在门静脉增强、延迟性增强、瘤周强化及廓清时间方面比较差异均有统计学意义(P<0.05),但两组在动脉期增强、始增时间表、达峰时间方面比较差异均无统计学意义(P>0.05)。复发组患者治疗前及治疗后肿瘤体积均大于未复发组,治疗后的ADC值小于未复发组,差异均有统计学意义(P<0.05)。与术前瘤区相比较,术后肿瘤坏死区、碘油沉积区的ADC值均升高,差异均有统计学意义(P<0.05),但肿瘤复发区与术前瘤区的ADC值比较差异无统计学意义(P>0.05)。38例复发组患者共56个病灶进行CEUS及CE-MRI检查,在患者术前术后病灶体长短径及评估中,二者评估结果比较差异无统计学意义(P>0.05),对患者术后残留活性病灶数进行检查,CE-MRI的检出率高于CEUS,差异有统计学意义(P<0.05)。经DSA检查,确诊复发的38例患者经CEUS、CE-MRI检查确诊为复发的分别为29、34例;未复发的64例患者中经CEUS、CE-MRI检查确诊为未复发的分别为62、63例。CE-MRI检查与DSA检查结果一致性检验Kappa值为0.893,高于CEUS检查与DSA检查结果一致性检验Kappa值(0.760)(P<0.05)。以DSA检查结果为金标准,患者经CEUS检查复发的准确率、敏感度、特异度Objective To explore the use of contrast-enhanced ultrasound(CEUS),contrast-enhanced magnetic resonance imaging(CE-MRI) in follow-up after transarterial chemoembolization(TACE) and microwave ablation for hepatocellular carcinoma.Methods A total of 102 patients(156 lesions) of hepatocellular carcinoma treated in Chongqing Qijiang District People's Hospital from August 2019 to May 2022 were retrospectively selected.They were received TACE or microwave ablation interventional therapy,were examined by CEUS and CE-MRI,with the gold standard,and the follow-up period was one year.Results DSA examination was performed on the patients,and the results were as follows:102 patients with hepatocellular carcinoma had recurrence in 38 patients(52 lesions) within 1 year after surgery,and 64 patients(104 lesions) had no recurrence.There were statistically significant differences in portal vein enhancement,delayed enhancement,peritumoral enhancement,and clearance time between the recurrent group and the non recurrent group(P<0.05),but there were no statistically significant differences in arterial phase enhancement,initiation schedule,and peak time between the two groups(P>0.05).The tumor volume before and after treatment in the recurrent group patients was larger than that in the non recurrent group,and ADC value after treatment was less than that in the non recurrent group,the differences were statistically significant(P<0.05).Compared with the preoperative tumor area,the ADC values in the tumor necrosis area and iodo oil deposition area increased,the differences were statistically significant(P<0.05),but there were no statistically significant differences in the ADC values between the tumor recurrence area and the preoperative tumor area(P>0.05).A total of 56 lesions were examined in 38 relapsed patients by CEUS and CE-MRI.There was no statistically significant difference in the assessment of the length and diameter of the lesion before and after surgery(P>0.05).In the number of residual active lesions was examined,the detectio

关 键 词：肝细胞癌 超声造影 动态增强磁共振成像 经动脉化学栓塞 微波消融 随访 

分 类 号：R735.7[医药卫生—肿瘤]