增强CT联合超声造影在HCC患者TACE疗效评估中的应用

Contrast-enhanced CT combined with contrast-enhanced ultrasound in evaluation of efficacy of TACE for patients with hepatocellular carcinoma

目的探讨增强CT联合超声造影在肝细胞癌(hepatocellular carcinoma,HCC)患者经导管肝动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)疗效评估中的应用价值。方法回顾性分析2020年12月至2022年12月在聊城市人民医院进行TACE治疗的96例HCC患者临床资料,男53例,女43例;年龄(52.69±4.08)岁。所有患者均接受TACE治疗,并于术后1个月行增强CT、超声造影及数字减影血管造影(DSA)检查。以DSA检查结果为金标准,评价超声造影、增强CT、增强CT联合超声造影对肿瘤残留的诊断效能,使用Kappa检验进行一致性分析,并观察残留病灶的影像学表现。结果96例患者经TACE治疗1个月后,共发现肿瘤残留15例,占15.63%;超声造影诊断肿瘤残留11例,占11.46%;增强CT诊断肿瘤残留10例,占10.42%;增强CT联合超声造影诊断肿瘤残留13例,占13.54%。对超声造影、增强CT、增强CT联合超声造影对肿瘤残留诊断效能及Kappa值进行分析,结果显示增强CT联合超声造影灵敏度、特异度、准确度、阴性预测值、阳性预测值、Kappa值分别为80.00%、98.77%、95.83%、96.39%、92.31%、0.833,均高于超声造影、增强CT。结论增强CT联合超声造影在HCC患者TACE疗效评估中应用优势明显,可作为TACE治疗后疗效评估的有效手段。

Objective To investigate the value of contrast-enhanced computed tomography(CECT)combined with contrast-enhanced ultrasound(CEUS)in the evaluation of the efficacy of transcatheter arterial chemoembolization(TACE)for patients with hepatocellular carcinoma(HCC).Methods The clinical data of 96 patients with HCC who underwent TACE in Liaocheng People's Hospital were analyzed retrospectively.Among the 96 patients,there were 53 males and 43 females;they were(52.69±4.08)old.The Child-pugh classification results showed that there were 49 cases of grade A and 47 cases of grade B.All the patients received CECT,CEUS,and digital subtraction angiography(DSA)examinations 1 month after surgery.The DSA results were taken as the golden standard to evaluate the diagnostic performance of CEUS,CECT,and CEUS combined with CECT for residual tumors.The Kappa test was used for consistency analysis,and the imaging findings of residual lesions were observed.Results One month after TACE,DSA found 15 cases of residual tumors,accounting for 15.63%.CEUS diagnosed 11 cases(11.46%)of residual tumors;CECT diagnosed 10 cases(10.42%)of residual tumors;CEUS combined with CECT diagnosed 13 cases(13.54%)of residual tumors.The diagnostic sensitivity,specificity,accuracy,negative predictive value,positive predictive value,and Kappa value of CEUS combined with CECT(80.00%,98.77%,95.83%,96.39%,92.31%,and 0.833)were higher than those of CEUS and CECT.Conclusions The combination of CECT and CEUS has significant advantages in evaluating the efficacy of TACE for patients with HCC.It can be used as an effective method for evaluating the efficacy after TACE.