MRI与超声在肝细胞癌TACE联合RFA治疗后的应用  

Application of MRI and Ultrasound in Hepatocellular Carcinoma after TACE Combined with RFA

作　　者：吕亚会 敬子洋 朱鹏飞[3] 王冰[4] 张浩[1] LYU Yahui;JING Ziyang;ZHU Pengfei;WANG Bing;ZHANG Hao(Medical Imaging Department,Heilongjiang Provincial Hospital(Harbin Institute of Technology Affiliated Heilongjiang Provincial Hospital),Harbin 150006,Heilongjiang,P.R.China;Ultrasound Department,Heilongjiang Provincial Hospital(Harbin Institute of Technology Affiliated Heilongjiang Provincial Hospital),Harbin 150006,Heilongjiang,P.R.China;Department of Infectious Diseases,Heilongjiang Provincial Hospital(Harbin Institute of Technology Affiliated Heilongjiang Provincial Hospital),Harbin 150006,Heilongjiang,P.R.China;Medical Department,Heilongjiang Provincial Hospital(Harbin Institute of Technology Affiliated Heilongjiang Provincial Hospital),Harbin 150006,Heilongjiang,P.R.China)

机构地区：[1]黑龙江省医院(哈尔滨工业大学附属黑龙江省医院)医学影像部,黑龙江哈尔滨150006 [2]黑龙江省医院(哈尔滨工业大学附属黑龙江省医院)超声科,黑龙江哈尔滨150006 [3]黑龙江省医院(哈尔滨工业大学附属黑龙江省医院)感染内科,黑龙江哈尔滨150006 [4]黑龙江省医院(哈尔滨工业大学附属黑龙江省医院)医务部,黑龙江哈尔滨150006

出　　处：《影像科学与光化学》2024年第3期201-208,共8页Imaging Science and Photochemistry

基　　金：黑龙江省自然科学基金资助项目(L2021H068)。

摘　　要：目的:探讨磁共振成像(MRI)与超声在肝细胞癌经肝动脉插管化疗栓塞术(TACE)联合射频消融(RFA)治疗后诊断中的应用。方法:选择2020年1月至2022年12月,黑龙江省医院收治的96例肝细胞癌患者为研究对象,均接受TACE联合RFA治疗,根据病灶大小的不同分为大病灶组(48例,肿瘤直径>3 cm)和小病灶组(48例,肿瘤直径≤3 cm)。采用MRI、超声、数字减影血管造影(DSA)对患者治疗前后的病灶改善情况进行影像学检查,比较两组治疗前后的影像学结果差异,将DSA结果作为金标准,探析MRI、超声在肝细胞癌预后诊断中的应用价值。结果:治疗后超声PI值[(15.21±1.85)dB]高于小病灶组[(10.14±1.06)dB],MRI ADC值[(1.09±0.18)×10^(-3) mm^(2)/s]、DSA ICratio值(0.55±0.19)均低于小病灶组[(1.31±0.21)×10^(-3) mm^(2)/s、0.71±0.21],差异有统计学意义(P<0.05)。大病灶组中MRI的确诊率、灵敏度、特异度、阳性预测值、阴性预测值分别为97.92%、96.77%、100.00%、100.00%、94.44%,高于超声的(68.75%、70.97%、64.71%、78.57%、55.00%),差异有统计学意义(P<0.05);小病灶组中MRI的确诊率、灵敏度、特异度、阳性预测值、阴性预测值分别为93.75%、92.31%、95.46%、96.00%、91.30%,高于超声的(60.42%、57.69%、63.64%、65.22%、56.00%),差异有统计学意义(P<0.05)。结论:在肝细胞癌TACE联合RFA治疗后超声、MRI均能达到较显著的检出效果,但MRI的确诊率、特异度、灵敏度高;两种检查方式在肝细胞癌治疗后影像检查中各有一定优劣势,可结合患者具体病情、家庭背景等科学、合理地选择适宜的影像学检查方式。Objective:To investigate the application of magnetic resonance imaging(MRI)and ultrasound in the diagnosis of hepatocellular carcinoma after transcatheter arterial chemoembolization(TACE)combined with radiofrequency ablation(RFA).Methods:A total of 96 patients with hepatocellular carcinoma treated in Heilongjiang Provincial Hospital from January 2020 to December 2022 were selected as the study subjects.All of them received TACE combined with RFA and were divided into large lesion group(48 cases,tumor diameter>3 cm)and small lesion group(48 cases,tumor diameter≤3 cm)according to different lesion sizes.MRI,ultrasound and digital subtraction angiography(DSA)were used to conduct imaging examination of the improvement of lesions before and after treatment.The difference in imaging results before and after treatment was compared between the two groups,and DSA results were taken as the gold standard to explore the application value of MRI and ultrasound in the prognosis of hepatocellular carcinoma.Results:After treatment,ultrasound PI values were significantly higher in the large lesion group[(15.21±1.85)dB]compared to the small lesion group[(10.14±1.06)dB],and the MRI ADC value[(1.09±0.18)×10^(-3) mm^(2)/s]and DSA ICratio values(0.55±0.19)were lower in the large lesion group compared to the small lesion group[(1.31±0.21)]×10^(-3) mm^(2)/s,0.71±0.21],the difference was statistically significant(P<0.05).The diagnostic rate,sensitivity,specificity,positive predictive value,and negative predictive value of MRI in the large lesion group were 97.92%,96.77%,100.00%,100.00%,and 94.44%,respectively,which were higher than those of ultrasound at 68.75%,70.97%,64.71%,78.57%,and 55.00%,with statistical significance(P<0.05).The diagnostic rate,sensitivity,specificity,positive predictive value,and negative predictive value of MRI in the small lesion group were 93.75%,92.31%,95.46%,96.00%and 91.30%,respectively,which were higher than ultrasound by 60.42%,57.69%,63.64%,65.22%,and 56.00%,with statistical significance(P<0.05).C

关 键 词：肝细胞癌 磁共振成像 超声 肝动脉插管化疗栓塞术 射频消融 影像诊断 

分 类 号：R735.7[医药卫生—肿瘤] R445[医药卫生—临床医学]