R_(2)^(*)值在肝细胞癌射频消融术后病灶边缘强化灶鉴别诊断中的应用

Application of R_(2)^(*)value in the differential diagnosis of the peripheral enhancement of hepatocellular carcinoma after radiofrequency ablation

目的:探讨磁共振血氧水平依赖(BOLD)成像在肝细胞癌(HCC)射频消融术后病灶周边异常强化灶定性诊断中的应用价值。方法:将79例明确诊断为HCC并进行射频消融术的患者纳入研究,所有患者在术后随访过程中定期采用BOLD序列行MRI检查,随访时间为1.0~9.2个月,平均(4.1±2.7)个月。测量消融灶周围的异常强化灶(HCC残留/复发灶、炎性反应带)、射频消融灶和肝实质的R_(2)^(*)值并采用方差分析进行比较。HCC残留/复发灶和炎性反应带主要根据临床表现、随访变化或病理进行诊断。使用ROC曲线分析R_(2)^(*)值鉴别HCC残留/复发灶与炎性反应带的诊断效能。结果:79例患者随访过程中共发现128处边缘强化灶,61处诊断为肿瘤残留/复发,67处诊断为炎性反应带。HCC残留/复发和炎性反应带的R_(2)^(*)值分别为(72.1±24.1)和(105.6±29.5)Hz,两者间的差异有统计学意义(P<0.001)。HCC残留/复发与肝实质的R_(2)^(*)值的差异有统计学意义(P<0.01);HCC残留/复发与射频消融病灶的R_(2)^(*)值差异无统计学意义(P>0.05)。R_(2)^(*)值鉴别HCC残留/复发与炎性反应带的最佳截断值为95.40 HZ,相应的诊断敏感度为85.2%、特异度为67.1%、阴性预测值为83.3%。结论:磁共振血氧水平依赖成像能够有效鉴别HCC射频消融术后HCC残留/复发与炎性反应带,有助于早期发现肿瘤残留/复发,改善患者的预后。

Objective:The aim of this study was to investigate the value of blood oxygen level-dependent(BOLD)-MRI in the qualitative diagnosis of abnormal enhancement around hepatocellular carcinoma after radiofrequency ablation.Methods:79 patients with clearly diagnosed HCC underwent radiofrequency ablation were included in the study.All patients underwent MRI scan with BOLD sequence during the postoperative follow-ups.The follow-up interval time was 1.0 to 9.2 months,with an average of(4.1±2.7)months.The R_(2)^(*)values of abnormal enhancement lesion(residual/recurrent HCC lesion or inflammatory reaction zone),radiofrequency ablation lesion and liver parenchyma around the ablation lesion were measured and compared by one-way analysis of variance.Residual/recurrent HCC lesions and inflammatory reaction zone were diagnosed based on clinical manifestations,follow-up changes and/or pathology.The ROC curve was used to analyze the diagnostic efficacy of R_(2)^(*)value to distinguish the residual/recurrent HCC from the inflammatory reaction zone.Results:128 lesions with marginal enhancement were found during follow-ups,of which 61 were diagnosed as resi-dual or recurrent tumor and 67 were clinically diagnosed as inflammatory reaction zone.The R_(2)^(*)value of residual/recurrent HCC lesions was(72.1±24.1)Hz.The R_(2)^(*)value of inflammatory reaction zone was(105.6±29.5)Hz.The difference of the R_(2)^(*)value between the two groups was statistically significant(P<0.001).The difference of R_(2)^(*)value between residual/recurrent HCC and liver parenchyma was statistically significant(P<0.01);there was no significant difference in R_(2)^(*)value between residual/recurrent HCC and radiofrequency ablation lesion(P>0.05).The best cut-off value of R_(2)^(*)value for differentiating inflammatory reaction zone from residual/recurrent HCC was 95.40Hz.The sensitivity,specificity and the negative predictive value of the cut-off value were 85.2%,67.1%and 83.3%,respectively.Conclusion:Blood oxygen level-dependent MRI can effectively distinguish the residual/recurrent HCC from the inflammatory reaction zone after radiofrequency ablation in patients with HCC,this can be helpful for early detection of residual/recurrent tumor and to improve the prognosis.