超声造影与增强MRI在评价肝癌TACE术后疗效的应用比较

Contrast-enhanced ultrasonography versus contrast-enhanced MRI in the evaluation of therapeutic effect of TACE for HCC: comparison of application value

目的探究超声造影、增强 MRI 在肝癌经 TACE 术后疗效评价中的应用价值。方法收集2018 年 1 月至 2018 年 8 月接受 TACE 治疗的 100 例肝癌患者(共 170 个病灶),术后 1 周内分别进行增强MRI、对比剂增强超声(CEUS)检查,对其结果进行 Kappa 检验及 McNemer 检验,比较其对检出残存病灶的灵敏度、特异度、准确度及两种检查结果的一致性。结果以最终诊断结果为依据,84 个 CEUS 造影、增强 MRI 均提示病灶存活,74 个病灶 CEUS、增强 MRI 均提示灭活,12 个病灶增强 MRI 提示存活,而CEUS 漏诊;增强 MRI 检查与最终检查结果完全一致,Kappa=1,P>0.05,而 CEUS 与增强 MRI 的 Kappa=0.859,P<0.05,增强 MRI 与 CEUS 的诊断吻合度较高,CEUS、MRI 诊断残存病灶的灵敏度,特异度,阳性预测值,阴性预测值比较,分别为 87.5%对 100.0%,100%对 100%,100%对 100%,86.0%对 100%。结论CEUS 能准确评估肝癌 TACE 术后是否有残存/复发病灶,且操作简单、方便、安全、价廉,在临床广泛普及,可作为肝癌 TACE 术后疗效评估的可靠方法,对于长期随访,CEUS 应辅以增强 MRI 进行全面评估。

Objective To discuss the application value of contrast- enhanced ultrasonography (CE-US) and contrast- enhanced MRI (CE - MRI) in evaluating therapeutic effect of transcatheter arterial chemoembolization (TACE) for hepatocellular carcinoma (HCC). Methods A total of 100 HCC patients (170 lesions in total), who received TACE during the period from January 2018 to August 2018, were enrolled in this study. Both CE-MRI and CE-US were performed in all patients within one week after TACE. The imaging findings were analyzed by using Kappa test and McNemer test. The sensitivity, specificity and accuracy in the detection of residual lesions were compared between the two imaging methods. The consistency of results between CE- MRI and CE- US was analyzed. Results Based on the final diagnosis, both CE-MRI and CE-US indicated that the presence of survival focus (residual and/or recurrent lesion) was found in 84 lesions, and the complete inactivation of HCC focus was seen in 74 lesions. Twelve lesions were diagnosed as surviving focus by CE-MRI, which were missed by CE-US. CE-MRI diagnoses were in complete agreement with final results (Kappa=1, P>0.05), while Kappa value between CE-US and CE-MRI was 0.859 (P <0.05). The diagnostic coincidence between CE - MRI and CE - US was quite high. The sensitivity, specificity, positive predictive value and negative predictive value in diagnosing residual and/or recurrent lesions of CE-US vs CE-MRI were 87.5% vs 100.0%, 100% vs 100%, 100% vs 100% and 86.0% vs 100%, respectively. Conclusion CE - US can accurately determine whether there are residual and/or recurrent lesions after TACE for HCC. CE - US is simple, convenient, safe and economic, and it has already been widely used in clinical practice. CE- US can be used as a reliable method to evaluate the curative effect of TACE for HCC. For clinical long-term follow- up, CE-US should be supplemented by CE-MRI so as to make a comprehensive evaluation of HCC.