增强CT与增强MRI检出肝细胞癌病灶及判断其强化类型的价值比较

Comparison of the Value of Contrast-Enhanced CT and Contrast-Enhanced MRI in Detecting Hepatocellular Carcinoma Lesions and Judging Their Enhancement Types

目的 比较增强CT与增强MRI(CE-MRI)在检出肝细胞癌(HCC)病灶与判断其强化类型等方面的价值。方法将成都医学院第一附属医院2020年3月至2022年3月术前同期行增强CT与CE-MRI检查的HCC患者82例作为研究对象。回顾影像学图像,结合病理结果比较两种方法检出HCC病灶及判断其强化类型的差异。结果 82例患者中共检出90个病灶,其中病理证实为HCC病灶83个、良性病灶7个。83个HCC病灶中直径> 2 cm的33个,直径≤2 cm的50个。90个良恶性病灶中,增强CT检出79个,CE-MRI检出87个。83个HCC病灶中,增强CT检出74个,CE-MRI检出81个,差异病灶为直径较小的7个HCC病灶。医师分析病灶特征后,增强CT诊断良性5个、HCC74个,CE-MRI诊断良性6个、HCC81个,差异病灶为1个血管瘤和7个直径较小的HCC病灶。比较增强CT与CE-MRI诊断病灶的结果,其检出病灶的总体灵敏度差异无统计学意义(P> 0.05),但CE-MRI的灵敏度与准确率均高于增强CT(P<0.05)。83个HCC病灶中,> 2 cm者33个,≤2 cm者50个。增强CT与CE-MRI对> 2 cm的HCC病灶检出率比较,差异无统计学意义(P> 0.05);CE-MRI对≤2 cm病灶的检出率高于增强CT(P<0.05)。83个HCC病灶中,增强CT检出78个病灶富血供、5个病灶乏血供;CE-MRI检出80个病灶富血供、3个病灶乏血供,后3个病灶在增强CT上同为乏血供。增强CT与CE-MRI对血供判定的Kappa值为0.476,P<0.05,具有较高一致性。结论 增强CT与CE-MRI对HCC病灶的检出与强化类型的判断均具有较高价值,其中CE-MRI对≤2 cm HCC病灶有更高的检出率。

Objective To compare the value of contrast-enhanced CT and contrast-enhanced MRI(CE-MRI)in detecting hepatocellular carcinoma(HCC)lesions and judging their enhancement types.Methods A total of 82 HCC patients(44 males and 38 females)who underwent contrast-enhanced CT and CE-MRI before surgery in the First Affiliated Hospital of Chengdu Medical College from March 2020 to March 2022 were included.Their age ranged from 32 to 66(50.62±6.17)years.The imaging images were reviewed,and the differences between the two methods in detecting HCC lesions and judging their enhancement types were compared in combination with pathological results.Results A total of 90 lesions were detected in 82 patients,of which 83 were pathologically confirmed HCC lesions and 7 were benign lesions.Of the 83 HCC lesions,33 were>2 cm in diameter,and 50 were≤2 cm in diameter.Among the 90 benign and malignant lesions in the whole group,79 were detected by contrast-enhanced CT and 87 were detected by CE-MRI.Among the 83 HCC lesions,74 were detected by contrast-enhanced CT and 81 were detected by CE-MRI. The difference lesions were 7 HCClesions with smaller diameters. After analysis of the characteristics of the lesions by physicians,5 benign and 74 HCC lesionswere diagnosed by contrast-enhanced CT,6 benign and 81 HCC lesions were diagnosed by CE-MRI,and the differencelesions were 1 hemangioma and 7 HCC lesions with smaller diameters. Comparison of contrast-enhanced CT and CE-MRI inthe diagnosis of lesions in the whole group showed that there was no significant difference in the overall sensitivity of the twoin detecting lesions( P>0.05),but the sensitivity and accuracy of CE-MRI were higher than those of contrast-enhanced CT( P< 0.05). Of the 83 HCC lesions,33 were >2 cm and 50 were ≤2 cm in diameter. There was no significant difference in thedetection rate of HCC lesions> 2 cm in diameter between contrast-enhanced CT and CE-MRI (P>0.05),but the detectionrate of CE-MRI for lesions≤ 2 cm was higher than that of contrast-enhanced CT. Among the 83 HCC lesions,78 lesionswere hypervascular and 5 were hypovascular in contrast-enhanced CT,while 80 lesions were hypervascular and 3 werehypovascular in CE-MRI,and the 3 hypovascular lesions in CE-MRI were also hypovascular in contrast-enhanced CT. TheKappa value of contrast-enhanced CT and CE-MRI for the determination of blood supply was 0.476,P< 0.05,with highconsistency. Conclusion Both contrast-enhanced CT and CE-MRI are of high value in the detection of HCC lesions and inthe judgment of enhancement types. And CE-MRI has a higher detection rate for HCC lesions ≤ 2 cm in diameter.