多层螺旋CT与磁共振成像对原发性肝癌经肝动脉化疗栓塞术后疗效评价

Evaluation of MSCT and MRI on the postoperatively curative effect of TACE for patient with PHC

目的:探讨多层螺旋CT(MSCT)与磁共振成像(MRI)对原发性肝癌(PHC)经肝动脉化疗栓塞(TACE)术后疗效评价的准确性。方法:选取医院收治的120例PHC患者,均在行TACE术后2~6个月来院复查,并行MSCT、MRI和数字减影血管造影(DSA)3种检查。以DSA为金标准,比较MSCT和MRI检查对术后病灶残留,复发诊断的准确率、灵敏度、特异度以及对病灶肿瘤包膜的检出率。结果:经DSA造影检查,120例患者共计检测到168个病灶,其中残留或复发病灶124个。MSCT对术后病灶残留或复发诊断的准确率、灵敏度和特异度分别为79.76%、72.58%和100.00%;MRI对术后病灶残留或复发诊断的准确率、灵敏度和特异度分别为94.05%、91.94%和100.00%,MRI对术后病灶残留或复发诊断的准确率和灵敏度均显著高于MSCT,其差异有统计学意义(x^2=7.803,x^2=9.499;P<0.05);MSCT和MRI对TACE术后肿瘤包膜检出率为3.57%和10.71%,MRI对TACE术后肿瘤包膜检出率显著高于MSCT,其差异有统计学意义(x^2=13.567,P<0.05)。结论:MSCT与MRI对PHC患者TACE术后疗效均具有较准确的评价,但MSCT诊断易受多种因素干扰,而MRI能更加全面、客观评价术后病灶残留或复发以及包膜病灶情况,更符合临床实际需求。

Objective： To explore the accuracies of evaluation of multislice spiral CT（MSCT） and magnetic resonance imaging（MRI） on the postoperatively curative effect of transcatheter arterial chemoembolization（TACE） for patient with primary hepatic carcinoma（PHC）. Methods： 120 patients with PHC were selected in this research. And 2-6 months after they received TACE, all of them were implemented re-examination by using MSCT, MRI and digital subtraction angiography（DSA）. The DSA was used as gold standard, and the postoperative lesion residual, the accuracy, sensitivity, specificity and detectable rate of tumor capsule of MSCT and MRI were further compared. Results： By contrast examination of DSA, 168 lesions were found in 120 patients, of whom 124 were residual or recurrent lesions. The accuracy, sensitivity and specificity of MSCT in diagnosing residual or recurrent lesions were 79.76%, 72.58% and 100%, respectively. While these indicators of MRI were 94.05%, 91.94% and 100%, respectively. The accuracy and sensitivity of MRI in diagnosing residual or recurrent lesions were significantly higher than those of MSCT, and the difference was statistically significant（x2=7.803, x2=9.499, P〈0.05）. The detectable rates of MSCT and MRI for tumor capsule post TACE were 3.57% and 10.71%, respectively. And the detectable rate of MRI post TACE was significantly higher than that of MSCT, and the difference was statistically significant（x2=13.567, P〈0.05）. Conclusion： Both of MSCT and MRI have relatively accurate evaluation for the curative effect of patients with PHC post TACE, but it is easy that the diagnosis of MSCT is disturbed by many factors. Besides, MRI can obtain more comprehensive and objective evaluation for the situations of postoperative residual or recurrence of the lesion, and the lesion of the capsule, which is more in line with the demand of clinical practices.