MRI与增强CT在经动脉化疗栓塞术后原发性肝癌患者中的应用价值分析

Application value of MRI and enhanced CT in patients with primary liver cancer after transcatheter arterial chemoembolization

目的分析MRI与增强CT在经动脉化疗栓塞术(TACE)治疗后原发性肝癌(PLC)患者中的应用价值。方法选取2019年1月至2021年1月中国医科大学附属第一医院鞍山医院收治的89例PLC患者,均行TACE术治疗,并于完成TACE术后2~6个月内予以MRI、增强CT、数字减影血管造影(DSA)检查,观察各检查方法诊断TACE后病灶大小、门静脉癌栓塞、病灶包膜与供血动脉来源情况,并以DSA检查结果为金标准,比较MRI、增强CT诊断TACE后病灶直径≤5 cm、门静脉癌栓塞、有无包膜的效能及其评估TACE疗效的价值。结果MRI检出有包膜病灶较多,而增强CT检出较少。MRI、增强CT均发现PLC主要供血动脉为腹腔动脉,MRI检出结果数据与DSA一致;同时,MRI对病灶大小的检出一致性较差,增强CT对病灶包膜的检出一致性较差;MRI对门静脉癌栓塞、病灶包膜的检出一致性正常;增强CT对病灶大小、门静脉癌栓塞、病灶包膜的检出一致性正常。MRI与CT对病灶≤5 cm、门静脉癌栓塞、病灶有包膜的检出率比较差异无统计学意义。MRI对病灶直径≤5 cm者的灵敏度、诊断符合率均高于增强CT,MRI对有无包膜者的灵敏度高于增强CT,差异有统计学意义(P<0.05),其余两两比较差异无统计学意义。结论MRI与增强CT各有优劣,但MRI在经TACE治疗后PLC患者中的应用价值高于增强CT,其可提高对病灶直径≤5 cm者的灵敏度、诊断符合率及有无包膜者的灵敏度。

Objective To analyze the application value of MRI and enhanced CT in patients with primary liver cancer(PLC)after transcatheter arterial chemoembolization(TACE).Methods A total of 89 PLC patients admitted to Anshan Hospital,the First Affiliated Hospital of China Medical University from January 2019 to January 2021 were selected and treated with TACE.MRI,enhanced CT and digital subtraction angiography(DSA)were performed within 2 to 6 months after TACE,the lesion size,portal vein cancer embolization,focal envelope and source of supplying arteries were observed after each examination method in the diagnosis of TACE,and the efficacy of MRI and enhanced CT in the diagnosis of focal diameter≤5 cm,portal vein cancer embolization,and the presence of envelope after TACE were compared,and the value of evaluating the efficacy of TACE was compared,using DSA as the gold standard.Results There were more capsular lesions detected by MRI,but less lesions detected by enhanced CT.Both MRI and enhanced CT showed that the main supplying artery of PLC was abdominal artery,and the results of MRI were consistent with DSA.At the same time,MRI had poor consistency in detecting lesion size,and enhanced CT had poor consistency in detecting lesion envelope.MRI showed normal consistency in detecting portal vein carcinoma embolism and lesion envelope.The detection of lesion size,portal vein carcinoma embolism and lesion envelope by enhanced CT was consistent.There was no significant difference between MRI and CT in the detection rate of lesions≤5 cm,portal vein cancer embolism and lesions with envelope.The sensitivity and diagnostic coincidence rate of MRI in patients with lesion diameter≤5 cm were higher than those of enhanced CT,and the sensitivity of MRI in patients with or without capsule was higher than that of enhanced CT,the differences were statistically significant(P<0.05),and the other pairwise comparisons were not statistically significant.Conclusion MRI and enhanced CT have their advantages and disadvantages,but MRI is more valuable than enhanced CT in PLC patients after TACE treatment,which can improve the sensitivity of patients with focal diameter≤5 cm,diagnostic coincidence rate and sensitivity of patients with or without capsule.