MRI检查对肝癌患者肿瘤包膜、经导管动脉化疗栓塞治疗后残留病灶的诊断价值及对肿瘤复发的预测价值  

Diagnostic value of MRI examination for tumor capsule and residual tumor lesions after transcatheter arterial chemoembolization treatment in patients with liver cancer and its predictive value for tumor recurrence

作　　者：王刚 李涛 周支贵 李芳苹 殷庭辉 汪胜梅 WANG Gang;LI Tao;ZHOU Zhigui;LI Fangping;YIN Tinghui;WANG Shengmei(Department of Imaging,Hospital of Guangzhou Xinshi(Guangzhou Fosun Chancheng Hospital),Guangzhou 510410,Guangdong,China;Department of Anesthesiology,Hospital of Guangzhou Xinshi(Guangzhou Fosun Chancheng Hospital),Guangzhou 510410,Guangdong,China)

机构地区：[1]广州新市医院(广东药科大学广州复星禅诚医院)影像科,广州5104100 [2]广州新市医院(广东药科大学广州复星禅诚医院)麻醉科,广州5104100

出　　处：《癌症进展》2024年第24期2683-2687,2703,共6页Oncology Progress

基　　金：中国老年保健协会临床研究课题(KT202407002)。

摘　　要：目的探讨MRI检查对肝癌患者肿瘤包膜、经导管动脉化疗栓塞(TACE)治疗后残留病灶的诊断价值及对肿瘤复发的预测价值。方法88例肝癌TACE患者均行数字减影血管造影(DSA)、MRI、CT检查,以DSA检查结果为金标准,比较CT、MRI检查对肿瘤包膜、肿瘤残留病灶的诊断价值。比较不同病灶区域MRI检查的表现弥散系数(ADC)值。对所有患者随访6个月,比较复发(n=34)与未复发(n=34)患者MRI检查的ADC值。采用受试者工作特征(ROC)曲线及曲线下面积(AUC)分析MRI检查ADC值对肝癌患者TACE治疗后肿瘤复发的预测价值。结果DSA检查结果显示,88例肝癌TACE患者中,肿瘤残留病灶57例,未见肿瘤残留病灶31例;有肿瘤包膜27例,无肿瘤包膜61例。MRI检查诊断肿瘤残留病灶的准确度及灵敏度均明显高于CT检查,差异均有统计学意义(P﹤0.01)。MRI检查诊断肿瘤包膜的准确度、灵敏度、特异度均明显高于CT检查,差异均有统计学意义(P﹤0.01)。治疗后,碘油沉积区、液化坏死区、富血供区ADC值及平均ADC值均明显高于治疗前,差异均有统计学意义(P﹤0.01)。未复发患者治疗前后ADC值及ΔADC值均高于复发患者,差异均有统计学意义(P﹤0.05)。?ADC值预测肝癌患者TACE治疗后肿瘤复发的AUC为0.856,高于治疗前后ADC值的0.641、0.818,此时的灵敏度为91.20%,特异度为63.00%。结论MRI检查对肝癌患者肿瘤包膜、TACE治疗后残留病灶以及肿瘤复发方面具有较高的诊断/预测价值。与CT检查相比,MRI检查诊断肿瘤包膜的软组织分辨率更高,能更清晰地显示肿瘤内部结构,还能通过检测治疗前后不同病灶区域ADC值的变化预测肝癌患者的复发风险。Objective To explore the diagnostic value of MRI examination for tumor capsule and residual tumor le-sions after transcatheter arterial chemoembolization(TACE)treatment in patients with liver cancer and its predictive val-ue for tumor recurrence.Method A total of 88 patients with liver cancer who underwent TACE were examined by digi-tal subtraction angiography(DSA),MRI and CT examinations.DSA examination results were used as the gold standard,the diagnostic value of CT and MRI for residual tumor lesions and tumor capsule were compared.The apparent diffusion coeffecient(ADC)values of MRI in different lesion areas were compared.All patients were followed up for 6 months,and the ADC values of MRI examination were compared between patients with recurrence(n=34)and without recurrence(n=34).Receiver operating characteristic(ROC)curve and area under the curve(AUC)were used to analyze the predic-tive value of ADC values of MRI examination for recurrence in liver cancer patients after TACE treatment.Result DSA results showed that among 88 patients who underwent TACE,57 cases had residual tumor lesions and 31 cases had no re-sidual tumor lesions.There were 27 cases with tumor capsule and 61 cases without tumor capsule.The accuracy and sen-sitivity of MRI examination in the diagnosis of residual tumor lesions were significantly higher than those of CT examina-tion,and the differences were statistically significant(P<0.01).The accuracy,sensitivity and specificity of MRI examina-tion in the diagnosis of tumor capsule were significantly higher than those of CT examination,and the differences were statistically significant(P<0.01).After treatment,the ADC values of iodine oil deposition area,liquefied necrosis area,blood supply rich area and the average ADC value were significantly higher than those before treatment,and the differ-ences were statistically significant(P<0.01).ADC andΔADC values before and after treatment in patients without recur-rence were higher than those in patients with recurrence,and the differences were s

关 键 词：肝癌 经导管动脉化疗栓塞 数字减影血管造影 MRI CT 

分 类 号：R735.7[医药卫生—肿瘤]