影像学检查评估TACE治疗的原发性肝癌患者术后残余肿瘤活性价值研究

The value of US,CT and MRI in the evaluation of tumor activity in patients with primary liver cancer after TACE intervention

目的探讨超声(US)、电子计算机断层扫描(CT)和磁共振成像(MRI)检查评估原发性肝癌(PLC)患者在经导管动脉栓塞化疗(TACE)治疗术后肿瘤活性的价值。方法2015年3月~2019年1月我院放射介入科行TACE治疗的60例PLC患者,术后3~5周行US、CT、MRI及数字减影血管造影(DSA)检查。以DSA检查结果为金标准,评判US、CT和MRI对残余病灶活性检出率的差异。结果在60例PLC患者,术后DSA检测出72个病灶,以此为金标准,结果MRI检出65个(90.3%)病灶,US检出34个(47.2%)病灶,CT检出55个(76.4%)病灶,提示US检出率最低(P<0.05);MRI检出的灵敏度、特异度和准确性分别为87.5%、95.8%和83.3%,而US检出分别为41.6%、97.9%和39.5%,CT检出分别为75.0%、89.5%和64.5%,提示MRI检出的灵敏度和准确性显著高于US或CT检查(P<0.05),而三种方法检出的特异度无显著性差异(P>0.05)。结论介入手术治疗后,需采用影像学方法检查及时评估残余肿瘤活性,以决定后期治疗,以MRI检查的效能最好,但其费用可能较高。

Objective The aim of this study was to explore the value of ultrasound(US),computerized tomography(CT)and magnetic resonance imaging(MRI)in the evaluation of intrahepatic tumor activity in patients with primary liver cancer(PLC)after interventional therapy.Methods 60 patients with PLC were treated with transcatheter arterial chemoembolization(TACE)in our hospital between March 2015 and January 2019.The US,CT,MRI and digital subtraction angiography(DSA)were performed 3 to 5 weeks after operation.The results of DSA were used as gold standard to observe the efficacies of US,CT and MRI in evaluating residue tumor activities.Results Out of 60 patients with PLC,the DSA examination demonstrated 72 lesions 3 to 5 weeks after TACE,and based on which,the MRI showed 65(90.3%)lesions,the US showed 34(47.2%)lesions,and the CT scan showed 55(76.4%)lesions,suggesting the poor US detections(P<0.05);the sensitivity(Se),specificity(Sp)and accuracy(Ac)of MRI were 87.5%,95.8%and 83.3%,while those by US were 41.6%,97.9%and 39.5%,and by CT were 75.0%,89.5%and 64.5%,indicating that the Se and Ac of MRI scan were superior to US or CT,and the Sp by the three methods were similar(P<0.05).Conclusion MRI is of high value in evaluating intrahepatic residue tumor activity in patients with PLC after TACE.