3.0 T MRI动态增强扫描对肝细胞肝癌介入治疗疗效的评价

The assessment of therapeutic effect of transcatheter arterial chemoembolization and radiofrequency ablation in hepatocellular carcinoma by 3.0T MRI dynamic contrast-enhanced imaging

目的:评价3.0T MRI动态增强扫描监测肝细胞肝癌(HCC)经肝动脉化疗栓塞(TACE)及射频消融(RFA)治疗后肿瘤残存或复发的价值。方法:选择40例经TACE或RFA治疗后的HCC患者,于TACE或RFA治疗后2～3个月内行MRI检查,MRI检查后2～4d内行DSA检查,观察MRI动态增强扫描各时相病灶的MRI征象和时间-信号强度曲线,判断原发病灶有无肿瘤残存或复发以及有无新发病灶,并与DSA、临床资料对照。结果:40例HCC患者共发现88个病灶,MRI动态增强扫描显示48个坏死灶,40个病灶有肿瘤残存或复发;DSA结合临床检查显示47个病灶为肿瘤坏死,41个病灶有肿瘤残存或复发。与DSA结合临床检查相比,MRI动态增强扫描发现肿瘤残存或复发的一致性好(Kappa值=0.931,P<0.05),敏感性97.9%,特异性95.1%,阳性预测值95.8%,阴性预测值97.5%,诊断正确率96.6%。结论:3.0T MRI动态增强扫描能清楚显示HCC经TACE或RAF治疗后原发病灶残存或复发,是评价HCC介入治疗疗效的理想方法。

Objective： To analyze the value of 3.0T MRI dynamic contrast-enhanced scan in the assessment of the lesions after transcatheter arterial chemoembolization （TACE） and radiofrequency ablation （RFA） in hepatocellular carcinoma （HCC）. Methods：Forty HCC patients were enrolled to receive TACE or RFA firstly. Then all patients underwent contrast-enhanced 3.0T MRI scan at 2-3 months after TACE or RFA. DSA examinationg were performed in all patients 2-4 days after MRI scans. The MRI signs of the lesion in each phase of dynamic contrast-enhanced sequence and time-signal intensity curve were observed to determine if the primary lesion was tumor （residual and new lesions） or necrosis,and compared with DSA. Results： 88 viable lesions occurred in 40 HCC patients after TACE or RFA. Contrast-enhanced MRI showed 48 lesions of complete necrosis and 40 local residual or recurrent lesions,while DSA combined with clinical examination revealed 47 lesions as tumor necrosis,41 lesions as residual tumor or recurrence. The sensitivity, specificity, positive predictive value, negative predictive value and accuracy of MRI were 97.9 %, 95.1%, 95.8%, 97.5 %, 96.6%respectively. There was a good correspondence between contrast enhancement MRI and DSA in detecting viable tumors after TACE or RFA （Kappa value =0. 931, P 〈0.05）. Conclusion： Contrast-enhanced MRI may be used to distinguish the necrotic tissues,viable residual or recurrent tumor tissues in HCC after TACE or RFA.