64排CT与DSA及C臂CT检出肝癌小病灶的对比

Comparison on 64-slice CT,DSA and C-arm CT in detecting small lesions of hepatocellular carcinoma

目的比较64排CT、DSA和C臂CT对肝癌小病灶（直径≤3.0 cm）的检出能力。方法对48例肝癌患者先行64排CT扫描,再行肝动脉DSA、TACE和C臂CT扫描。2周内复查CT（碘化油CT）,由3名影像科医师对64排CT、DSA、C臂CT和碘化油CT图像进行分析,计数4种方法对直径≤3.0 cm病灶的显示情况,并以碘化油CT诊断结果作为标准,用McNemar检验比较64排CT、DSA和C臂CT诊断肝癌小病灶的检出率。结果碘化油CT证实48例患者共133个病灶（直径0.5~3.0 cm）,其中64排CT检出55个（55/133,41.35%）,DSA检出110个（110/133,82.70%）,C臂CT检出130个（130/133,97.74%）,三者间两两比较,差异均有统计学意义（P〈0.0001）。根据病灶大小将133个病灶分为3组,A组（直径0.5~1.0 cm）98个病灶,B组（直径1.1~2.0 cm）27个,C组（直径2.1~3.0 cm）8个。64排CT、DSA、C臂CT分别检出A组病灶29、76和95个,B组19、26和27个,C组7、8和8个。结论 C臂CT可提高对肝癌小病灶的检出率。

Objective To compare the detecting ability of 64-slice CT,DSA and C-arm CT of small lesions of hepatocellular carcinoma（HCC）.Methods Totally 48 HCC patients diagnosed clinically underwent 64-slice CT,DSA,and C-arm CT examination,and were followed up using lipiodol CT 2 weeks after DSA.Lipiodol CT images were used as the diagnostic reference.Images acquired with 64-slice CT,DSA,C-arm CT and lipiodol CT were retrospectively reviewed by 3 radiologists.The number of detected lesions with diameter ≤3.0 cm in each examination was counted separately.McNemar test was used to compare the detecting ability of 64-slice CT,DSA,and C-arm CT.Results A total of 133 lesions（0.5—3.0 cm） in 48 patients were confirmed with lipiodol CT.64-slice CT detected 55 lesions（55/133,41.35%）,DSA detected 110（110/133,82.70%）,while C-arm CT detected 130（130/133,97.74%） lesions.Statistical differences of detection rats were found between every two methods（all P0.0001）.The 133 lesions were further classified into 3 groups according to the lesion size,including 98 lesions in group A（0.5—1.0 cm）,27 lesions in group B（1.1—2.0 cm） and 8 lesions in group C（2.1—3.0 cm）.64-slice CT,DSA,and C-arm CT detected 29,76,and 95 lesions in group A,19,26 and 27 lesions in group B,and 7,8 and 8 lesions in group C,respectively.Conclusion C-arm CT can detect more small lesions of HCC than 64-slice CT and DSA,and help to improve detection rate of small lesions of HCC during TACE.