螺旋CT与磁共振成像对乙型肝炎肝硬化背景小肝癌的诊断对比研究

Comparative research of helical CT and MRI in diagnosis of small hepatocellular carcinoma patients with hepatitis B cirrhosis

目的比较64层螺旋CT与磁共振成像(MRI)对乙型肝炎肝硬化背景小肝癌病灶的诊断效果。方法选取2014年1月至2016年12月乙型肝炎肝硬化患者140例,所有患者共有163个小肝癌病灶,按照肿瘤直径分为小肝癌组(肿瘤直径为1~3cm)和微小肝癌(肿瘤直径<1cm)组,其中小肝癌114个,微小肝癌49个。所有患者均行CT(平扫、动脉期、门静脉期、平衡期)检查和MRI[T2加权像(T2WI)、扩散加权成像(DWI)、梯度回波同相(IN-PHASE)、梯度回波反相(OUT-PHASE)、容积快速三维成像(LAVA)、平扫、动脉期、门静脉期及平衡期]检查,比较2种方法检出率及准确率情况。结果 LAVA动脉期和CT动脉期对小肝癌病灶的诊断率最高,CT平扫最低;LAVA动脉期对微小肝癌病灶的诊断率最高,LAVA平衡期最低;CT各期及MRI INPHASE、LAVA平扫、LAVA平衡期对小肝癌和微小肝癌的诊断率差异有统计学意义(P<0.05),MR-T2WI、DWI、OUT-PHASE、LAVA动脉期及LAVA门静脉期对小肝癌和微小肝癌的诊断率差异无统计学意义(P>0.05);CT与MRI诊断小肝癌的准确率差异无统计学意义(P>0.05);CT对微小肝癌诊断的准确率明显低于MRI(P<0.05)。CT对小肝癌诊断ROC曲线下面积为0.897(P<0.05),灵敏度为87.2%,特异度为85.7%;MRI对小肝癌诊断ROC曲线下面积为0.913(P<0.05),灵敏度为90.6%,特异度为87.5%。CT对微小肝癌诊断ROC曲线下面积为0.747(P<0.05),灵敏度为74.6%,特异度为76.5%;MRI对微小肝癌诊断ROC曲线下面积为0.906(P<0.05),灵敏度为89.7%,特异度为83.3%。结论 MRI相较于64层螺旋CT对微小肝癌病灶的诊断能力更优,具有较高的临床应用和推广价值。

Objective To compare the diagnostic value of 64-slice spiral CT and MRI in small hepatocellular carcinoma patients with hepatitis B cirrhosis.Methods One hundred and forty cases of patients with hepatitis B cirrhosis from January 2014 to December 2016 were enrolled in this study. There were 163 small hepatocellular carcinomas in these patients, which were divided into small hepatocellular carcinoma group （tumor diameter： 1-3 cm） 114 cases and micro hepatocellular carcinoma （tumor diameter 〈1 cm） 49 cases. All patients were examined with MDCT （native phase, arterial phase, portal venous phase and equilibrium phase） and MRI [T2WI, DWI, IN-PHASE, OUT-PHASE, LAVA, native phase, arterial phase, portal venous phase and equilibrium phase], positive rate and accuracy rate of them were analyzed.Results Diagnosis rate of LAVA arterial phase and CT arterial phase in small hepatocellular carcinomas （SHCC） were the highest, diagnosis rate of CT scan was the lowest; Diagnosis rate of LAVA arterial phase in micro hepatocellular carcinomas （MHCC） was the highest, diagnosis rate of LAVA equilibrium phase was the lowest; There were significant differences in the diagnostic rate of SHCC and MHCC with each phase of CT and MRI IN-PHASE, LAVA scan and LAVA equilibrium phase（ P 〈0.05）, there had no significant differences in the diagnostic rate of SHCC and MHCC with MR-T2WI, DWI, OUT-PHASE, LAVA arterial phase and LAVA portal venous phase（ P 〉0.05）; There was no significant difference between CT and MRI in the diagnosis of SHCC （ P 〉0.05）; Diagnosis rate of CT for MHCC was lower than that of MRI （ P 〈0.05）; The area under ROC curve of CT for SHCC was 0.897 （ P 〈0.05）, sensitivity was 87.2%, specificity was 85.7%; The area under ROC curve of MRI for SHCC was 0.913 （ P 〈0.05）, sensitivity was 90.6%, specificity was 87.5%; The area under ROC curve of CT for MHCC was 0.747 （ P 〈0.05）, sensitivity was 74.6%, specificity was 76.5%, The area under ROC curve of MRI MHCC was 0.906（ P 〈0.05）, sensitivity was 89.7%, and specificity was 83.3%.Conclusion Compared with 64-slice spiral CT, diagnosis of MRI in MHCC is superior, which has high clinical application and popularization value.