探讨钆喷酸葡胺增强MRI与螺旋CT多期增强扫描对肝硬化背景下肝癌的诊断效果

The effect of multi-phase enhanced MRI and spiral CT scanning on the diagnosis of hepatocellular carcinoma in cirrhotic background

目的:探讨钆喷酸葡胺增强MRI与螺旋CT多期增强扫描对肝硬化背景下肝癌的诊断效果。方法:选取2019年5月至2022年6月诊治的93例肝硬化背景下肝脏局灶性病变患者作为研究对象,以病理结果为金标准确诊肝癌共42例、非肝癌共51例,在金标准确诊前予以增强MRI和螺旋CT多期增强扫描,对比两种检查方法与金标准符合情况,采用四格表法计算阳性、阴性预测值,采用ROC曲线模型分析增强MRI与螺旋CT多期增强扫描诊断肝癌的AUC值、敏感度及特异度。结果:93例肝脏局灶性病变患者经增强MRI检查后,阳性预测值为86.05%,阴性预测值为90.00%,与金标准相比,一致性较好(Kappa=0.762,P<0.05)。经螺旋CT多期增强扫描后,阳性预测值为70.45%,阴性预测值为77.55%,与金标准相比,一致性一般(Kappa=0.481,P<0.05)。其中,增强MRI与螺旋CT多期增强扫描的准确率相比,差异具有统计学意义(χ^(2)=5.948,P=0.015)。肝癌组患者的Ve、Ktrans、Kep等参数均高于对照组患者(P<0.05)。肝癌组与非肝癌组患者在动脉期、门静脉、延迟期影像表现比较中,差异具有统计学意义(P<0.05)。ROC曲线分析显示,增强MRI、螺旋CT多期增强诊断肝癌的AUC值分别为(0.882、0.742,P<0.05);敏感度分别为88.10%、73.80%;特异度分别为88.20%、74.50%,增强MRI与螺旋CT多期增强AUC比较,Z=2.128、P=0.003。结论:增强MRI扫描诊断肝硬化背景下肝癌的准确率高于螺旋CT多期增强扫描。

Objective:To investigate the diagnostic effect of gadolinium penate meglumine enhanced MRI and spiral CT in the diagnosis of hepatocellular carcinoma in the background of cirrhosis.Methods:A total of 93 patients with focal liver lesions under the background of cirrhosis diagnosed and treated from May 2019 to June 2022 were selected as research objects.With pathological findings as the gold standard,a total of 42 patients with liver cancer and 51 patients with non-liver cancer were confirmed by gold standard,and enhanced MRI and spiral CT multi-phase enhanced scanning were performed before gold standard diagnosis.The positive and negative predictive values were calculated by using the four-cell table method.The AUC value,sensitivity and specificity of enhanced MRI and spiral CT multi-phase enhanced scanning in the diagnosis of liver cancer were analyzed by ROC curve model.Results:The positive predictive value was 86.05%and the negative predictive value was 90.00%after enhanced MRI in 93 patients with focal liver lesions,which was consistent with the gold standard(Kappa=0.762,P<0.05).After multi-phase enhanced spiral CT scanning,positive predictive value was 70.45%and negative predictive value was 77.55%,with general consistency compared with the gold standard(Kappa=0.481,P<0.05).Among them,the accuracy of enhanced MRI and spiral CT was significantly different(χ^(2)=5.948,P=0.015).The Ve,Ktrans and Kep parameters in HCC group were higher than those in control group(P<0.05).There were statistically significant differences in the imaging findings of arterial stage,portal vein and delayed stage between HCC group and non-HCC group(P<0.05).ROC curve analysis showed that the AUC values of enhanced MRI and spiral CT in the diagnosis of HCC were 0.882 and 0.742,P<0.05,respectively.The sensitivity were 88.10%and 73.80%,respectively.The specificity was 88.20%and 74.50%,respectively.The AUC of enhanced MRI and spiral CT were compared,Z=2.128 and P=0.003.Conclusion:The accuracy of enhanced MRI scanning in the diagnosis of hepatocellular carcinoma in the background of cirrhosis is higher Spiral CT multiphase enhanced scan.