MSCT联合CTA检查在肝细胞癌经导管动脉化疗栓塞术后患者复发中的诊断价值

Diagnostic value of MSCT combined with CTA in recurrence of hepatocellular carcinoma after transcatheter arterial chemoembolization

目的研究多层螺旋CT(MSCT)联合CT血管造影(CTA)检查对肝细胞癌(HCC)经导管动脉化疗栓塞术(TACE)后患者复发中的诊断价值。方法选择2017年1月至2019年1月于第九四二医院接受TACE治疗的97例HCC患者纳入研究。对所有受试者均进行MSCT、CTA以及MSCT联合CTA检查,比较不同检查方式诊断患者术后复发的效能。结果MSCT检查结果显示:97例受检者中,共有30例受检者共检出45个新发病灶,直径0.4~1.8(0.92±0.31)cm。动脉期明显强化病灶32个,轻度强化10例,无明显强化3个;静脉期高密度影20个,等密度影18个,低密度影7个;延迟期高密度或稍高密度影24个,低密度边缘清晰10个,低密度边缘不清晰11个。CTA检查结果显示:97例受检者中有32例患者存在新发病灶血管异常,共47支血管:包括肝动脉变异18支,肝外侧支供血动脉29支。以病理诊断为金标准,MSCT联合CTA诊断HCC患者TACE术后复发的灵敏度、特异度以及准确度分别为97.50%(39/40)、96.49%(55/57)、96.91%(94/97),均高于MSCT检查的75.00%(30/40)、77.19%(44/57)、76.29%(74/97)以及CTA检查的80.00%(32/40)、80.70%(46/57)、80.41%(78/97)(均P<0.05)。结论MSCT联合CTA检查诊断HCC患者TACE术后复发的效能较佳,值得临床推广应用。

Objective To investigate the diagnostic value of multi-slice spiral CT(MSCT)combined with CT angiography(CTA)in the recurrence of hepatocellular carcinoma(HCC)after transcatheter arterial chemoembolization(TACE).Methods 97 HCC patients who received TACE therapy in the 942 Hospital from January 2017 to January 2019 were enrolled in the study.MSCT,CTA and MSCT combined with CTA were performed in all subjects to compare the efficacy of different examination methods in diagnosing postoperative recurrence.Results MSCT results showed that 45 new lesions were detected in 30 of the 97 patients,with a diameter of 0.4-1.8 cm,with an average of(0.92±0.31)cm.In arterial phase,32 lesions were significantly enhanced,10 were mildly enhanced and 3 were not significantly enhanced.In the venous phase,there were 20 high-density shadows,18 isodensity shadows and 7 low-density shadows.In the delay period,there were 24 shadows with high density or slightly high density,10 with clear edge of low density,and 11 with unclear edge of low density.The results of CTA showed that there were 47 vessels in 32 cases of 97 patients,including 18 cases of hepatic artery variation and 29 cases of blood supply artery of lateral hepatic branch.Taking pathological diagnosis as the gold standard,the sensitivity,specificity and accuracy of MSCT combined with CTA in the diagnosis of HCC recurrence after TACE were 97.50%(39/40),96.49%(55/57),96.91%(94/97),which were higher than 75.00%(30/40),77.19%(44/57),76.29%(74/97)of MSCT and 80.00%(32/40),80.70%(46/57)and 80.41%(78/97)of CTA respectively(all P<0.05).Conclusions MSCT combined with CTA has a better efficacy in the diagnosis of TACE recurrence in HCC patients,which is worthy of clinical application.