MRI和DECT对原发性肝癌TACE术后疗效判断的价值

Signigicance of MRI and DECT in judging the efficacy of TACE in patients with primary liver cancer

目的探讨磁共振成像(MRI)和双能CT(DECT)对原发性肝癌导管肝动脉化疗栓塞(TACE)术后疗效判断的价值。方法选取2017年2月至2019年12月间辽宁营口市中心医院收治的行TACE术的90例原发性肝癌患者,术后均行MRI和DECT及数字减影血管造影(DSA)检查,以DSA为金标准,评估MRI和DECT对DSA术后患者残留病灶、复发病灶和病灶包膜等的价值。结果90例PHC患者(118个病灶)中,TACE术后DSA检查发现复发、残余病灶68个(57.6%)。以DAS检查及随访结果为金标准,MRI检查对PHC患者TACE术后肿瘤残余和复发的敏感度为91.2%,特异度为100.0%;DECT检查敏感度为76.5%,特异度为100.0%。MRI检查碘油沉积Ⅰ、Ⅱ、Ⅲ和Ⅳ型分别为4、32、21和5个,DECT为2、24、21和5个。MRI共检出肿瘤包膜35个(29.7%),DECT共检出肿瘤包膜8个(6.8%),差异有统计学意义(x^2=20.73,P<0.05)。ROC曲线分析显示,MRI和DECT检查诊断PHC术后复发、转移的AUC为0.956、0.882,准确性较高;预测敏感度和特异度:MRI为91.2%和100.0%,DECT为76.5%和100.0%。MRI诊断价值高于DECT。结论MRI对TACE术后肿瘤复发和残余病灶检出的敏感性和准确性高于DECT。

Objective To investigate the significance of magnetic resonance imaging(MRI)and dual-energy CT(DECT)in judging the efficacy of transcatheter hepatic arterial chemoembolization(TACE)in patients with primary hepatic cancer(PHC).Methods A total of 90 patients with primary liver cancer who underwent TACE at Yingkou Central Hospital from February 2017 to December 2019 were selected as subjects.All the patients underwent MRI,DECT and digital subtraction angiography(DSA)for postoperative reexamination.The significance of MRI and DECT for the detection of residual lesions,recurrent lesions,and lesion capsule after DSA was evaluated with the results of DSA as gold standard.Results Among the 90 PHC patients(118 lesions),DSA examination after TACE discovered 68 recurrent and residual lesions(57.62%).The sensitivity and specificity of MRI was 91.2%and 100.0%,respectively for residual and recurrent lesions in PHC patients after TACE.The sensitivity and specificity of DECT test was76.5%and 100.0%,respectively.Four typeⅠ,32 typeⅡ,21 typeⅢand 5 typeⅣlipiodol deposition was found by MRI and 2 typeⅠ,24 typeⅡ,21 typeⅢand 5 typeⅣlipiodol deposition was found by DECT.Thirty-five(29.7%)tumor capsules were detected by MRI and 8(6.8%)tumor capsules were detected by DECT(P<0.05).In addition,ROC curve analysis showed that the AUC of MRI and DECT in diagnosing postoperative PHC recurrence and metastasis was 0.956 and 0.882 indicating high accuracy and the sensitivity and specificity were 91.2%and 100%for MRI and 76.5%and 100%for DECT,which suggest the diagnostic significance of MRI was higher than DECT.Conclusion The sensitivity and accuracy of MRI was higher than that DECT in detecting tumor recurrence and residual lesions after TACE.