超声造影与增强MRI在肝细胞癌TACE疗效评估中的应用价值

Contrast-enhanced ultrasound and MRI in post-treatment evaluation of hepatocellular carcinoma after TACE

目的分析超声造影、增强MRI在肝细胞癌经导管肝动脉栓塞化疗(TACE)疗效评估中的应用价值。方法回顾分析2018年1月至12月连续在徐州医科大学附属医院诊治的60例原发性肝细胞癌患者资料,男性53例,女性7例,年龄范围47~84岁,平均61.9岁。60例(114个病灶)患者均接受TACE,术后1周内行超声造影、增强MRI、数字减影血管造影(DSA)检查。以DSA为金标准,比较超声造影、增强MRI诊断活性病灶的灵敏度、特异度、准确率及检查结果的一致性。结果DSA术中检查发现88个活性病灶,26个完全灭活病灶。超声造影发现78个活性病灶,36个完全灭活病灶。增强MRI发现88个活性病灶,26个完全灭活病灶。增强MRI检查准确率为100.0%(114/114),优于超声造影91.2%(104/114),差异有统计学意义(P<0.05)。增强MRI与超声造影检查结果的一致性检验Kappa值为0.781,一致性较强。直径≤5 cm的病灶,增强MRI诊断准确率100.0%(78/78),优于超声造影88.5%(69/78),差异有统计学意义(P<0.05)。直径>5 cm的病灶,增强MRI诊断准确率与超声造影比较,差异无统计学意义(P>0.05)。增强MRI诊断活性病灶的灵敏度高于超声造影,特异度一致。直径≤5 cm的病灶,增强MRI与超声造影诊断结果一致性检验Kappa值为0.747,>5 cm的病灶,Kappa值为0.873,一致较强。结论增强MRI和超声造影可作为肝细胞癌TACE术后疗效评估的可靠方法。

ObjectiveTo study the use of contrast-enhanced ultrasonography(CE-US)and contrast-enhanced MRI(CE-MRI)in evaluation of therapeutic effect of transcatheter arterial chemoembolization(TACE)on hepatocellular carcinoma(HCC).MethodsA retrospective study was conducted on 60 patients with HCC(with 114 lesions),who were treated with TACE in Affiliated Hospital of Xuzhou Medical University from January 2018 to December 2018.There were 53 males and 7 females,age ranged from 47 to 84(mean age 61.9)years.CE-US,CE-MRI and digital subtraction angiography(DSA)were performed in all these patients within one week after TACE.Using DSA as the gold standard,the sensitivity,specificity and accuracy in the detection of residual lesions were compared between the two imaging methods.The consistency of results between CE-US and CE-MRI was analyzed.ResultsCE-MRI and CE-US showed presence of active tumor foci(residual and/or recurrent lesion)in 78 lesions,and complete inactivation of HCC foci in 26 lesions.Ten lesions were diagnosed as active foci by CE-MRI,which were missed by CE-US.The diagnostic accuracy of CE-MRI was 100.0%(114/114),which was significantly better than the 91.2%(104/114)of CE-US(P<0.05).The Kappa value between CE-US and CE-MRI was 0.781.The diagnostic coincidence between CE-MRI and CE-US was quite high.Among small lesions of less than 5 cm,the diagnostic accuracy of CE-MRI was 100.0%(78/78),which was significantly better than the 88.5%(69/78)of CE-US(P<0.05).In large lesions of greater than 5 cm,the diagnostic accuracy of CE-MRI was comparable to that of CE-US.The difference was not significant(P>0.05).The sensitivity of CE-MRI in detection of active lesions was higher than that of CE-US,and the specificity of the two imaging methods was consistent.The Kappa value between CE-US and CE-MRI was 0.747 for small lesions of less than 5cm,and 0.873 for large lesions of greater than 5 cm.The diagnostic coincidence between CE-MRI and CE-US was quite high.ConclusionCE-MRI and CE-US can both be used as reliable imaging methods for evaluating the therapeutic effect of TACE for HCC.