CT和MRI对原发性肝癌TACE术后残留及新发病灶的诊断价值

Diagnostic Value of CT and MRI in the Residual and New Lesions of Primary Hepatocellular Carcinoma after TACE

目的对比X线计算机体层摄影术(CT)和磁共振成像(MRI)对原发性肝癌(PHC)肝动脉化疗栓塞术(TACE)术后残留及新发病灶的诊断价值。方法选取我院2018年3月至2021年12月行TACE术治疗的60例PHC患者作为研究对象,于术后3~6月对所有患者行CT及MRI检查,以数字减影血管造影(DSA)结果为“金标准”,对比CT及MRI对PHC患者TACE术后残留及新发病灶的评估价值。结果60例患者共82个病灶,DSA结果显示53个病灶存在肿瘤残余或为新发,残余/复发率为64.63%(53/82);CT扫描显示38个病灶残余或为新发,其中34个诊断正确,准确率为64.15%(34/53);MRI检查显示48个病灶残余或新发病灶,46个诊断正确,准确率为86.79%(46/48)。DSA结果显示存在34个碘油均匀沉积病灶中,5个病灶残余或为新发病灶,残余/复发率为14.71%(5/34),余48个碘油不均匀沉积病灶均为病灶残余或新发病灶,残余/复发率为100.00%(48/48);碘油均匀沉积病灶中,CT正确检出2个病灶残余或新发病灶(40.00%),MRI正确检出3个(60.00%);碘油不均匀沉积病灶中,CT正确检出32个病灶残余或新发病灶(66.67%),MRI正确检出43个(89.58%)。MRI判断TACE术后肿瘤残余或新生病灶的敏感度、特异度、诊断符合率、kappa值均高于CT(P<0.05)。结论与CT检查相比,MRI对PHC患者TACE术后残留及新发病灶的诊断价值更高,其对不同类型碘油沉积部位的肿瘤残余或新生病灶均具有较好的诊断优势。

Objective To compare the diagnostic value of X-ray computed tomography(CT)and magnetic resonance imaging(MRI)on residual and new lesions after transcatheter arterial chemoembolization(TACE)for primary hepatocellular carcinoma(PHC).Methods A total of 60 patients with PHC who underwent TACE in the hospital between March 2018 and December 2021 were selected as the research subjects.All patients underwent CT and MRI at 3 to 6 months after surgery.Digital subtraction angiography(DSA)results were taken as the"gold standard"to compare the evaluated value of CT and MRI on residual and new lesions after TACE in patients with PHC.Results There were 82 lesions in 60 patients.DSA results showed that 53 lesions were residual tumors or new lesions,with the residual/recurrence rate of 64.63%(53/82).CT scan revealed that 38 lesions were residual or new,of which 34 cases were correctly diagnosed,with an accuracy rate of 64.15%(34/53).MRI examination indicated 48 residual or new lesions,including 46 correctly diagnosed lesions,with an accuracy rate of 86.79%(46/48).DSA results showed that among the 34 lesions with uniform deposition of lipiodol,5 lesions were residual or new lesions with the residual/recurrence rate of 14.71%(5/34),and the remaining 48 lesions with uneven deposition of lipiodol were residual or new lesions with the residual/recurrence rate of 100.00%(48/48).Among the lesions with uniform deposition of lipiodol,CT correctly detected 2 residual or new lesions(40.00%),and MRI correctly detected 3 lesions(60.00%).Among the lesions with uneven deposition of lipiodol,32 residual or new lesions(66.67%)were correctly detected by CT and 43(89.58%)were correctly detected by MRI.The sensitivity,specificity,diagnostic coincidence rate and kappa value of MRI in judging tumor residual or new lesions after TACE were higher than those of CT(P<0.05).Conclusion Compared with CT,MRI has higher diagnostic value on residual and new lesions in patients with PHC after TACE,and it has better diagnostic advantages for tumor residual or new lesions in different types of lipiodol deposition sites.