MSCT对肝癌患者介入栓塞术疗效的预测价值

Value of MSCT in Predicting the Curative Effect of Interventional Embolization in Patients with Liver Cancer

目的分析多层计算机断层扫描(Multislice computed tomography,MSCT)对肝癌患者介入栓塞术疗效的预测价值。方法选取2014年7月~2018年6月我院收治的120例行经导管动脉化疗栓塞术(Transcatheter arterial chemoebolization,TACE)肝癌患者,均接受MSCT检查,并以血管造影为"金标准",分析MSCT影像表现与疗效相关性及MSCT对病灶复发或者残余预测的准确性。结果MSCT对病灶复发或者残余预测灵敏度83.33%(80/96),特异度92.06%(58/63),准确性86.79%(138/159),Kappa值为0.73;结节血供:动脉血供型38个、门静脉血供型27个、动脉与门静脉双重血供型36个、无血供型58个;碘油分布:密实型57个、缺损型38个、簇集型20个与稀少型44个;结节内有坏死灶119个,无坏死灶40个;结节内血供与术后6个月疗效呈负相关(P<0.05),碘油分布、结节内有坏死灶与术后6个月疗效呈正相关(P<0.05)。结论MSCT检测肝癌患者介入栓塞术后病灶复发或者残余具有较高准确性,可通过结节血供、碘油分布预测术后疗效,为其后续有效治疗方案的确定提供指导。

Objective To analyze the value of multi-slice computed tomography(MSCT) in predicting the curative effect of interventional embolization in patients with liver cancer. Methods A total of 120 patients with liver cancer who underwent transcatheter arterial chemoembolization(TACE) in the hospital during the period from July 2014 to June 2018 were enrolled in the study. All of them were examined by MSCT. With angiography as the golden standard, the correlation between MSCT imaging findings and curative effect and the accuracy of MSCT in prediction of recurrence or residual were analyzed. Results The sensitivity, specificity, accuracy and kappa value of MSCT in prediction of recurrence or residual were 83.33%(80/96), 92.06%(58/63), 86.79%(138/159) and 0.73. Nodular blood supply showed 38 of arterial blood supply type, 27 of portal vein blood supply types, 36 of arterial and portal vein blood supply types, and 58 without blood supply type. The distribution of lipiodol showed 57 of dense type, 38 of defective type, 20 of cluster type and 44 of rare type. There were 119 necrotic lesions in the nodules and 40 without necrotic lesions. The blood supply in the nodules was negatively correlated with the curative effect at 6 months after operation(P<0.05). The distribution of lipiodol and necrosis in the nodules were positively correlated with the curative effect at 6 months after operation(P<0.05). Conclusion MSCT is a highly accurate method for detecting recurrence or residual in patients with liver cancer after interventional embolization. It can be used to predict the postoperative curative effect through nodular blood supply and distribution of lipiodol, which provides guidance for the determination of effective follow-up treatment.