MRI在肝癌介入治疗后残留病灶及随访评估中的应用

Efficacy of MRI in the diagnosis of residual lesions and follow-up assessment of recurrence of hepatocellular carcinoma following interventional therapy

目的探讨MRI在经导管动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)治疗肝癌后残留病灶及随访评估中的应用。方法64例接受TACE的原发性肝癌(primary liver cancer,PLC)患者均于术前、术后3个月行常规DSA、CT、MRI检查。比较MRI、CT对介入治疗后残留病灶及复发的诊断能力。结果64例患者TACE术前DSA检查结果共发现95个病灶,术后3个月随访DSA复查,62个为肿瘤残留或复发病灶,33个未见肿瘤残留或复发。MRI诊断的准确率、灵敏度分别为94.7%、91.9%,高于CT的86.3%、79.0%,差异均有统计学意义(χ^2=3.93、4.16,P<0.05)。MRI对包膜的检出率(44.4%)高于CT的检出率(8.9%),差异有统计学意义(χ^2=15.55,P<0.05)。TACE术后碘油沉积良好区DWI呈均匀低或稍低信号,缺损区可呈高信号;复发病灶T2WI呈明显高信号。病灶的ADC值由高至低依次为肿瘤坏死区>碘油沉积区>术前瘤区、肿瘤复发区。结论MRI对原发性肝癌患者TACE术后病灶残留或复发具有较高的检出率,且准确度和灵敏度优于CT,可为肿瘤疗效预测及随访期间复发早期评价提供更多信息。

Objective To evaluate the efficacy of MRI in the diagnosis of residual lesions and follow-up assessment of recurrence after hepatocellular carcinoma is subjected to treatment with transcatheter arterial chemoembolization(TACE).Methods Firstly,64 patients with primary liver cancer(PLC)who were treated with TACE were subjected to conventional DSA,CT and MRI examinations three months before and after surgery.The efficacy of MRI and that of CT in the diagnosis of residual lesions and assessment of recurrence with the cancer having been treated with interventional therapy were then compared.Results A total of 95 lesions were found in 64 patients by DSA before TACE.Follow-up DSA examination conducted three months after surgery found 62 residual or recurrent tumor lesions.No residual or recurrent tumor was found in the remaining 33 lesions.The diagnostic accuracy and sensitivity of MRI were 94.7%and 91.9%,respectively,which were significantly higher than those of CT,which were 86.3%and 79.0%respectively.The differences were statistically significant(χ^2=3.93,4.16,P<0.05).The rate of detection of membrane by MRI was 44.4%,which was significantly higher than that of CT(8.9%).The difference was statistically significant(χ^2=15.55,P<0.05).After TACE the area with good iodine-oil deposition showed uniform low or slightly low signals on DWI whereas the defect area showed high signal.The T2WI of recurrence lesion showed prominently high signals.A comparison of the ADC values of the four loci of lesions found the pattern in terms of greatness or smallness of value as follows:tumor necrosis area>iodolipid deposition area>tumor recurrence area,preoperative tumor area.Conclusions MRI guarantees a higher rate of detection of residual or recurrence of lesions after TACE in patients with PLC.It is superior to CT in both accuracy and sensitivity,and hence gives better informed prediction of efficacy of tumor treatment therapy and follow-up assessment of recurrence.