CT、MRI检查对肝癌患者经动脉化疗栓塞术后残留或复发病灶的诊断价值

The Value of CT and MRI in Diagnosing Residual or Recurrent Lesions in Liver Cancer Patients after TACE Surgery

目的探讨CT、MRI检查诊断肝癌患者TACE术后残留或复发病灶的价值。方法选择中山大学附属第一医院2020年6月至2023年5月期间106例接受动脉化疗栓塞术(TACE)的肝癌患者,均接受CT、MRI及数字减影血管造影(DSA)检查,分析CT、MRI在病灶中的影像学表现,并以DSA为金标准,分析两组检查与金标准的一致性、诊断效能以及对残留或复发病灶具体类型的检出效能。结果DSA检查显示106例肝癌TACE术后患者中有134个病灶,其中83个为残留或复发病灶(阳性),51个为无病灶残留或复发病灶(阴性);在83个病灶中,无包膜57个,小病灶(直径≤5 cm)26个,分别占比68.67%(57/83)、31.33%(26/83);CT、MRI在动脉期信号方面对比有差异(P<0.05),在门脉期、延迟期信号方面对比无差异(均P>0.05);MRI与金标准一致性高于CT(Kappa值0.676 vs.0.394);MRI对于该类疾病的诊断敏感度、准确度均高于CT(P<0.05),特异度虽略高于CT,但二者对比无差异(P>0.05);MRI对于无包膜、小病灶(直径≤5 cm)的检出准确率均高于CT(P<0.05)。结论与CT检查诊断肝癌患者TACE术后残留或复发病灶相比,MRI诊断价值更高,能清晰显示病灶包膜及小病灶情况,提高残留或复发病灶检出率,可作为一种肝癌TACE术后疗效的评估方式。

Objective To explore the value of MRIand CT in diagnosing residual or recurrent lesions in liver cancer patients after transcatheter arterial chemoembolization(TACE).Methods 106 liver cancer patients who underwent TACE surgery in the First Affiliated Hospital of Sun Yat-sen University from June 2020 to May 2023 were selected,all of whom underwent CT,MRI,and digital subtraction angiography(DSA)examinations.The imaging manifestations of CT and MRI in the lesions were analyzed,and DSA was used as the gold standard to analyze the consistency between the two groups of examinations and the gold standard,diagnostic efficacy,and detection efficacy for specific types of residual or recurrent lesions.Results DSA examination showed 134 lesions in 106 patients with liver cancer after TACE,of which 83 were residual or recurrent lesions(positive)and 51 were non residual or recurrent lesions(negative);Among the 83 lesions,57 had no capsule and 26 had small lesions(diameter≤5 cm),accounting for 68.67%(57/83)and 31.33%(26/83)respectively;There was a difference in arterial phase signals between CT and MRI(P<0.05),but there was no difference in portal phase and delayed phase signals(P>0.05);The consistency between CT and the gold standard is poor,with a Kappa value of 0.394.The consistency between MRI and the gold standard is average,with a Kappa value of 0.676.The diagnostic sensitivity and accuracy of MRI for this type of disease were higher than those of CT(P<0.05).Although the specificity was slightly higher than that of CT,there was no difference in comparison between the two methods(P>0.05);The accuracy of MRI in detecting small lesions(diameter≤5 cm)without capsule was higher than that of CT(P<0.05).Conclusions Compared with CT examination for the diagnosis of residual or recurrent lesions in liver cancer patients after TACE,MRI has higher diagnostic value.It can clearly display the capsule and small lesions of the lesion,improve the detection rate of residual or recurrent lesions,and can be used as a method for evaluating the efficacy of TACE for liver cancer.