增强CT及MRI诊断原发性肝癌经导管动脉化疗栓塞后残留及病变的研究

Clinical Comparison of Residual and New Lesions after Transcatheter Arterial Chemoembolization(TACE)in Patients with Primary Liver Cancer Diagnosed by MRI and Enhanced CT

目的本研究旨在探讨磁共振成像(MRI)和增强CT(CECT)对原发性肝癌(primary liver cancer,PHC)经导管动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)后残留和新发病灶的诊断价值和准确性。方法研究对象为扬州大学第四临床医学院2021年1月至2022年1月收治的72例PHC患者,共92个病灶。所有患者均行TACE治疗,术后6个月随访。此外,所有患者均行数字减影血管造影(digital subtraction angiography,DSA)检查,并以DSA结果为金标准,评价MRI和CECT对肝癌患者TACE术后残留和新发病灶的诊断价值和准确性。结果两种诊断方法的特异性差异无统计学意义(P>0.05),但MRI的诊断准确率和敏感性明显高于CECT(P<0.05)。MRI检出的残留和新发病灶数明显高于多层螺旋CT(MSCT)(P<0.05),不同类型碘油沉积的PHC患者TACE后残留和新发病灶的检出率明显高于CECT(P<0.05)。术后MRI诊断的肿瘤包膜数明显高于CECT(P<0.05)。两种诊断方法对术后动脉期残余强化征象的评分差异无统计学意义(P>0.05)。此外,两种诊断方法对门静脉癌栓诊断及术后病变的血供来源无显著差异(P>0.05)。结论MRI对肝癌患者TACE术后残存和新发病灶的诊断准确率和敏感性均高于CECT。然而,这两种诊断方法在门静脉癌栓的诊断、病变的血供来源以及术后动脉期残余强化的评分上是相似的。

Objective The aim of this study was to investigate the diagnostic value and accuracy of magnetic resonance imaging(MRI)and enhanced CT(CECT)for residual and new lesions after transcatheter arterial chemoembolization(TACE)of primary liver cancer(PHC).Methods The study subjects were 72 PHC patients with 92 lesions treated from January 2021 to January 2022 in our institution.All patients underwent TACE and were followed up for 6 months after surgery.In addition,all patients underwent digital subtraction angiography(DSA),and the diagnostic value and accuracy of MRI and CECT for the detection of residual and new lesions after TACE in HCC patients were evaluated using the results of DSA as the gold standard.Results There was no significant difference in specificity between the two diagnostic methods(P>0.05),but the diagnostic accuracy and sensitivity of MRI were significantly higher than those of CECT(P<0.05).The number of residual and new lesions detected by MRI was significantly higher than that by multislice computed tomography(MSCT)(P<0.05),and the detection rate of residual and new lesions after TACE was significantly higher than that by CECT in PHC patients with different types of lipiodol deposits(P<0.05).The number of tumor envelopes diagnosed by postoperative MRI was significantly higher than that by CECT(P<0.05).There was no significant difference in the scores of residual enhancement signs in the arterial phase postoperatively between the two diagnostic methods(P>0.05).In addition,the diagnosis of portal vein tumor thrombus and the blood supply source of the postoperative lesion were not significantly different between the two diagnostic methods(P>0.05).Conclusion MRI has a higher diagnostic accuracy and sensitivity than CECT for the residual and new lesions after TACE in HCC patients.However,the two diagnostic methods are similar in terms of the diagnosis of portal vein tumor thrombus,the source of blood supply to the lesion,and the scoring of residual enhancement in the arterial phase postoperatively.