Computed tomography-based radiomics to predict early recurrence of hepatocellular carcinoma post-hepatectomy in patients background on cirrhosis

BACKGROUND The prognosis for hepatocellular carcinoma(HCC)in the presence of cirrhosis is unfavourable,primarily attributable to the high incidence of recurrence.AIM To develop a machine learning model for predicting early recurrence(ER)of posthepatectomy HCC in patients with cirrhosis and to stratify patients’overall survival(OS)based on the predicted risk of recurrence.METHODS In this retrospective study,214 HCC patients with cirrhosis who underwent curative hepatectomy were examined.Radiomics feature selection was conducted using the least absolute shrinkage and selection operator and recursive feature elimination methods.Clinical-radiologic features were selected through univariate and multivariate logistic regression analyses.Five machine learning methods were used for model comparison,aiming to identify the optimal model.The model’s performance was evaluated using the receiver operating characteristic curve[area under the curve(AUC)],calibration,and decision curve analysis.Additionally,the Kaplan-Meier(K-M)curve was used to evaluate the stratification effect of the model on patient OS.RESULTS Within this study,the most effective predictive performance for ER of post-hepatectomy HCC in the background of cirrhosis was demonstrated by a model that integrated radiomics features and clinical-radiologic features.In the training cohort,this model attained an AUC of 0.844,while in the validation cohort,it achieved a value of 0.790.The K-M curves illustrated that the combined model not only facilitated risk stratification but also exhibited significant discriminatory ability concerning patients’OS.CONCLUSION The combined model,integrating both radiomics and clinical-radiologic characteristics,exhibited excellent performance in HCC with cirrhosis.The K-M curves assessing OS revealed statistically significant differences.

Validated preoperative computed tomography risk estimation for postoperative hepatocellular carcinoma recurrence

AIM To develop and validate a risk estimation of tumor recurrence following curative resection of operable hepatocellular carcinoma(HCC).METHODS Data for 128 patients with operable HCC(according to Barcelona Clinic Liver Cancer imaging criteria) who underwent preoperative computed tomography(CT) evaluation at our hospital from May 1, 2013 through May 30, 2014 were included in this study. Follow-up data were obtained from hospital medical records. Follow-up data through May 30, 2016 were used to retrospectively analyze preoperative multiphasic CT findings, surgical histopathology results, and serum α-fetoprotein and thymidine kinase-1 levels. The χ~2 test, independent t-test, and Mann-Whitney U test were used to analyze data. A P-value of < 0.05 was considered statistically significant.RESULTS During the follow-up period, 38 of 128 patients(29.7%) had a postoperative HCC recurrence. Microvascular invasion(MVI) was associated with HCC recurrence(χ~2 = 13.253, P < 0.001). Despite postoperative antiviral therapy and chemotherapy, 22 of 44 patients with MVI experienced recurrence after surgical resection. The presence of MVI was 57.9% sensitive, 75.6% specific and 70.3% accurate in predicting postoperative recurrence. Of 84 tumors without MVI, univariate analysis confirmed that tumor margins, tumor margin grade, and tumor capsule detection on multiphasic CT were associated with HCC recurrence(P < 0.05). Univariate analyses showed no difference between groups with respect to hepatic capsular invasion, Ki-67 proliferation marker value, Edmondson-Steiner grade, largest tumor diameter, necrosis, arterial phase enhanced ratio, portovenous phase enhanced ratio, peritumoral enhancement, or serum α-fetoprotein level.CONCLUSION Non-smooth tumor margins, incomplete tumor capsules and missing tumor capsules correlated with postoperative HCC recurrence. HCC recurrence following curative resection may be predicted using CT.

Radiomics model based on contrast-enhanced computed tomography to predict early recurrence in patients with hepatocellular carcinoma after radical resection

BACKGROUND Radical resection remains an effective strategy for patients with hepatocellular carcinoma(HCC).Unfortunately,the postoperative early recurrence(recurrence within 2 years)rate is still high.AIM To develop a radiomics model based on preoperative contrast-enhanced computed tomography(CECT)to evaluate early recurrence in HCC patients with a single tumour.METHODS We enrolled a total of 402 HCC patients from two centres who were diagnosed with a single tumour and underwent radical resection.First,the features from the portal venous and arterial phases of CECT were extracted based on the region of interest,and the early recurrence-related radiomics features were selected via the least absolute shrinkage and selection operator proportional hazards model(LASSO Cox)to determine radiomics scores for each patient.Then,the clinicopathologic data were combined to develop a model to predict early recurrence by Cox regression.Finally,we evaluated the prediction performance of this model by multiple methods.RESULTS A total of 1915 radiomics features were extracted from CECT images,and 31 of them were used to determine the radiomics scores,which showed a significant difference between the early recurrence and nonearly recurrence groups.Univariate and multivariate Cox regression analyses showed that radiomics scores and serum alphafetoprotein were independent indicators,and they were used to develop a combined model to predict early recurrence.The area under the receiver operating characteristic curve values for the training and validation cohorts were 0.77 and 0.74,respectively,while the C-indices were 0.712 and 0.674,respectively.The calibration curves and decision curve analysis showed satisfactory accuracy and clinical utilities.Kaplan-Meier curves based on recurrence-free survival and overall survival showed significant differences.CONCLUSION The preoperative radiomics model was shown to be effective for predicting early recurrence among HCC patients with a single tumour.

A correlation of computed tomography perfusion and histopathology in tumor edges of hepatocellular carcinoma

BACKGROUND： The peripheral morphologic characteristics of hepatocellular carcinoma （HCC） reflect tumor growth patterns. Computed tomography （CT） perfusion is a new method to analyze hemodynamic changes in tissues. We assessed the relationship between CT perfusion and histopathologic findings in the periphery of HCC lesions. METHODS： Non-contrast CT, enhanced dual-phase CT, and CT perfusion were performed on 77 subjects （47 patients and 30 controls）. Based on the imaging findings of enhanced dual- phase CT, the tumor edges were classified into three types： type Ⅰ （sharp）; type Ⅱ （blurry）; and type Ⅲ （mixed）. The CT perfusion parameters included hepatic blood flow, hepatic arterial fraction, hepatic arterial perfusion, and hepatic portal perfusion. The tissue sections from resected specimens were subjected to routine hematoxylin and eosin staining and immunohistochemical staining for CD34. The correlations between microvessel density （MVD） and the CT perfusion parameters were analyzed using Pearson＇s product-moment correlation coefficient. Changes in the perfusion parameters in tumor edges of different tumor types were evaluated. RESULTS： Type Ⅰ （sharp）： the pathologic findings showed fibrous connective tissue capsules in the tumor edges, and an MVD 〈30/ram2. Type Ⅱ （blurry）： the histology showed that the edges were clear with no capsules and an MVD 〉30/ram2. Type Ⅲ （mixed）： the pathology was similar to that of types I and II, and an MVD 〉30/mm~. Hepatic blood flow, hepatic arterial fraction, hepatic arterial perfusion, and hepatic portal perfusion were significantly increased in the tumor edges of HCC patients compared to those of the controls （P〈0.05）. The correlation between CT perfusion parameters and MVD was higher in blurry tumor edges of type II than in those of types Ⅰ or Ⅲ. CONCLUSION： CT perfusion imaging of tumor edges may be helpful in revealing histopathological features, and indirectly reflect angiogenic changes of HCCs.

Recurrence of hepatocellular carcinoma with rapid growth after spontaneous regression

We report an 80-year-old man who presented with sponta- neous regression of hepatocellular carcinoma(HCC).He complained of sudden right flank pain and low-grade fever. The level of protein induced by vitamin K antagonist(PIVKA)- II was 1 137 mAU/mL.A computed tomography scan in November 2000 demonstrated a low-density mass located in liver S4 with marginal enhancement and a cystic mass of 68 mm×55 mm in liver S6,with slightly high density content and without marginal enhancement.Angiography revealed that the tumor in S4 with a size of 25 mm×20 mm was a typical hypervascular HCC,and transarterial chemoembolization was performed.However,the tumor in S6 was hypovascular and atypical of HCC,and thus no therapy was given.In December 2000,the cystic mass regressed spontaneously to 57 min×44 mm,and aspiration cytology revealed bloody fluid,and the mass was diagnosed cytologically as class I. The tumor in S4 was treated successfully with a 5 mm margin of safety around it.The PIVKA-II level normalized in February 2001.In July 2001,the tumor regressed further but presented with an enhanced area at the posterior margin.In November 2001,the enhanced area extended,and a biopsy revealed well-differentiated HCC,although the previous tumor in S4 disappeared.Angiography demonstrated two tumor stains,one was in S6,which was previously hypovascular, and the other was in S8.Subsequently,the PIVKA-II level started to rise with the doubling time of 2-3 wk,and the tumor grew rapidly despite repeated transarterial embolization with gel foam.In February 2003,the patient died of bleeding into the peritoneal cavity from the tumor that occupied almost the entire right lobe.Considering the acute onset of the symptoms,we speculate that local ischemia possibly due to rapid tumor growth,resulted in intratumoral bleeding and/or hemorrhagic necrosis,and finally spontaneous regression of the initial tumor in S6.

Role of Early Arterial Phase Multislice Helical CT Angiography in Evaluation of Hepatocellular Carcinoma

Objective: To investigate the clinical application of early arterial phase multislice CT angiog raphy (MSCTA) of hepatic vessels in evaluation of middle or advanced stage hepatocellular carcinoma. Methods: Trigger Bolus program was used to carry out MSCTA in early and late arterial phases and portal vein phase with single breath holding. Hepatic vessels were reconstructed from the original images of early arterial phase by post processing. The blood supply of tumor and normal liver tissue and the appearances of venous thrombosis and arteriovenous shunts were analyzed. Results: The MSCTA with early arterial phase could perfectly display the origin, shape and amount of feeding vessels to normal liver tissue and tumor in middle or advanced stage hepatocellular carcinoma. It had the ability of displaying the arteriovenous shunts better than that in conventional dual phased liver scanning. Conclusion: MSCTA of hepatic vessels with early arterial phase acquisition using multislice helical CT in middle or advance stage hepatocellular carcinoma has favorable and promising application. It can be used as an imaging method for comprehensive assessment of the hepatocellular carcinoma before treatment.

Comparison in Diagnosing the Postoperative Recurrence of Hepatocarcinoma between MSCT and DSA

Objective： To evaluate the value of MSCT and DSA in diagnosing the postoperative recurrence of hepatocellular carcinoma by analyzing the results of these two image examinations. Methods： Seventytwo patients with postoperative recurrence of hepatocellular carcinoma were subjected to MSCT and DSA of their livers. The interval of two examinations was 2 to 14 days. Results： In 51 cases （70.83%）, the recurrent lesions were multiple small nodules （type Ⅰ）, 9 cases （12.36%） were single nodule （type Ⅱ）, and the remaining 12 cases （16.81%） were unequal nodules （type Ⅲ）. The results of two examinations were discrepancy in 10 patients. In 7 cases having positive results in DSA, the number of small nodules in 5 cases displayed by DSA was more than that by MSCT, and 2 cases had negative results in MSCT. In 3 patients having positive results in MSCT, number of small nodules in 2 cases displayed by MSCT was more than that by DSA and 1 case had negative results in DSA. Conclusion： MSCT and DSA had difference in displaying the postoperative recurrent lesions of hepatocellular carcinoma. The combined application of MSCT and DSA would be beneficial to improve the diagnosis of recurrent lesions.

Detection of small hepatocellular carcinoma:Comparison of dynamic enhancement magnetic resonance imaging and multiphase multirow-detector helical CT scanning

AIM: To compare the gadolinium-enhanced multiphase dynamic magnetic resonance imaging (MRI) and multiphase multirow-detector helical CT (MDCT) scanning for detection of small hepatocellular carcinoma (HCC). METHODS: MDCT scanning and baseline MRI with SE T1-WI and T2-WI sequence combined with FMPSPGR sequence were performed in 37 patients with 43 small HCCs. Receiver operating characteristic (ROC) curves were plotted to analyze the results for modality. RESULTS: The areas below ROC curve (Az) were calculated. There was no statistical difference in dynamic enhancement MDCT and MRI. The detection rate of small HCC was 97.5%-97.6% on multiphase MDCT scanning and 90.7%-94.7% on MRI, respectively. The sensitivity of detection for small HCC on MDCT scanning was higher than that on dynamic enhancement MRI. The sensitivity of detection for minute HCC (tumor diameter ≤ 1 cm) was 90.0%-95.0% on MDCT scanning and 70.0%-85.0% on MRI, respectively. CONCLUSION: MDCT scanning should be performed for early detection and effective treatment of small HCC in patients with chronic hepatitis and cirrhosis during follow-up.

Multiphase hepatic scans with multirow- detector helical CT in detection of hypervascular hepatocellular carcinoma

BACKGROUND: Multirow-detector helical CT (MDCT) allows faster Z-axis coverage and improves longitudinal re- solution to scan the entire liver. This study was to evaluate the value of multiphase hepatic CT scans using MDCT in diagnosing hypervascular hepatocellular carcinoma (HCC). METHODS: Multiphase hepatic CT scans in 40 patients were carried out with a Marconi Mx8000 MDCT scanner. The scans of early arterial phase (EAP), late arterial phase (LAP) and portal venous phase (PVP) were started at 21, 34 and 85 seconds after injection of contrast medium, re- spectively. The number of detected lesions was calculated in each phase. The density of the liver and tumor was great- er than 1 cm for HCC, and the density of the liver and tumor in each phase was statistically calculated. RESULTS: A total of 61 lesions were found in the 40 pa- tients , and lesions greater than 1 cm were seen in 47 cases. The density differences between the liver and tumor were statistically significant (P<0.05) at the LAP and EAP and between the LAP, EAP and PVP. In the 61 lesions, the de- tectability in the EAP, LAP and the double arterial phases (DAP) was 32%, 87%, and 94%, respectively. Significant difference was found between the LAP plus PVP and the EAP plus PVP; but no significant difference was observed between the DAP plus PVP and the LAP plus PVP. CONCLUSIONS: The utility of MDCT scan in the liver has optimized the protocol of arterial phase scan. MDCT is possible to scan the entire liver in a real arterial phase and it is very valuable in the detection of small HCC.

Brain metastasis of hepatocellular carcinoma:A case report and review of the literature

Hepatocellular carcinoma (HCC) is one of the most frequent malignancies in the world. It is more common in far eastern countries and relatively rare in the United States and western European countries where at autopsy it accounts for only 1-2% of malignant rumors, The disease is usually manifested in the the 6^th and 7^th decade of life. HCC is one of the highly malignant neoplasms, Extrahepatic metastases are seen in 64% of patients with HCC. The lungs, regional lymph nodes, kidney, bone marrow and adrenals are common sites of HCC metastasis^[1-3], But, metastasis to brain and skull is extremely rare. Table I shows some of the reported cases of HCC with brain metastasis. These case reports reaffirms the complex and multidisciplinary care of these patients^[4-5].

Primary clear cell carcinoma in the liver: CT and MRI findings

AIM: To retrospectively analyze the computed tomography (CT) and magnetic resonance imaging (MRI) appearances of primary clear cell carcinoma of the liver (PCCCL) and compare the imaging appearances of PCCCL and common type hepatocellular carcinoma (CHCC) to determine whether any differences exist between the two groups. METHODS: Twenty cases with pathologically proven PCCCL and 127 cases with CHCC in the Second Affiliated Hospital of Sun Yat-sen University were included in this study. CT or MRI images from these patients were retrospectively analyzed. The following imaging findings were reviewed: the presence of liver cirrhosis, tumor size, the enhancement pattern on dynamic contrast scanning, the presence of pseudo capsules, tumor rupture, portal vein thrombosis and lymph node metastasis. RESULTS: Both PCCCL and CHCC were prone to occur in patients with liver cirrhosis, the association rate of liver cirrhosis was 80.0% and 78.7%, respectively (P > 0.05). The mean sizes of PCCCL and CHCC tumors were (7.28 ± 4.25) cm and (6.96 ± 3.98) cm, respectively. Small HCCs were found in 25.0% (5/20) of PCCCL and 19.7% (25/127) of CHCC cases. No significant differences in mean size and ratio of small HCCs were found between the two groups (P = 0.658 and 0.803, respectively). Compared with CHCC patients, PCCCL patients were more prone to form pseudo capsules (49.6% vs 75.0%, P = 0.034). Tumor rupture, typical HCC enhancement patterns and portal vein tumor thrombosis were detected in 15.0% (3/20), 72.2% (13/18) and 20.0% (4/20) of patients with PCCCL and 3.1% (4/127), 83.6% (97/116) and 17.3% (22/127) of patients with CHCC, respectively. There were no significant differences between the two groups (all P > 0.05). No patients with PCCCL and 2.4% (3/127) of patients with CHCC showed signs of lymph node metastasis (P > 0.05). CONCLUSION: The imaging characteristics of PCCCL are similar to those of CHCC and could be useful for differentiating these from other liver tumors (such as hemangioma and hepatic metastases). PCCCLs are more prone than CHCCs to form pseudo capsules.

Multi-slice CT angiography by triple-phase enhancement in preoperative evaluation of hepatocellular carcinoma

Background Triple-phase enhancement of multi-slice computed tomography (MSCT) has markedly improved the diagnostic accuracy of hepatocellular carcinoma (HCC), and MSCT angiography (MSCTA) has been proved useful in detecting vascular anatomy noninvasively. This study aimed to explore the value of MSCTA by triple-phase enhancement in preoperative evaluation of HCC.Methods Fifty-six consecutive cases of primary HCC scheduled for resection were studied with MSCTA by triple-phase enhancement. The raw data images were processed on a workstation for multiplanar reconstruction (MPR) and three-dimensional (3D) reconstruction. The findings after processing of the data were compared with those after surgery or intraoperative sonography. Results The false positive rate of MSCTA by triple-phase enhancement was 10.1% and its false negative rate was 4.3% in detecting HCC. No significant difference was observed in MSCTA and surgery or intraoperative sonography in detecting vascular anatomy anomalies and pathologic variations, whereas significant difference was found in detecting bile duct invasion with MSCT compared to intraoperative sonography.Conclusions MSCTA by triple-phase enhancement not only improves the detection of HCC, but also provides valuable preoperative information about hepatic vascular architecture and parenchyma. MSCTA by triple-phase enhancement is worthy of application as a non-invasive method in preoperative evaluation of HCC.

常规TACE术中DSA诊断肝细胞癌切除术后3个月内复发

目的探讨常规TACE术中DSA对肝细胞癌(HCC)切除术后3个月内复发的诊断价值。方法回顾性分析79例肝脏部分切除术后HCC患者的资料,所有患者均于术后3个月内接受常规TACE治疗,并于TACE前接受腹部CT或MR平扫及增强扫描,且于TACE治疗后1个月内接受碘油CT检查。以碘油CT结果为金标准,评价肝脏部分切除术后TACE中DSA与TACE前腹部CT或MRI对3个月内HCC肿瘤复发的诊断效能,对比分析二者诊断准确率。结果肝脏部分切除术后,TACE前腹部CT或MRI诊断3个月内HCC肿瘤复发的敏感度为70.31%(45/64),特异度为93.33%(14/15);TACE中DSA的敏感度为87.50%(56/64),特异度为93.33%(14/15)。TACE中DSA的诊断准确率明显高于TACE前腹部CT或MRI[88.61%(70/79)vs 74.68%(59/79),χ2=5.110 4,P=0.024]。结论TACE中DSA对发现肝脏部分切除术后3个月内的HCC复发病灶较腹部CT或MRI更为准确。

多普勒超声与肝动脉DSA联合碘油CT检查诊断微小肝癌及肝良性结节

目的探讨多普勒超声与肝动脉DSA联合碘油CT检查对微小肝癌及肝良性结节的诊断价值。方法回顾性分析100例因临床高度怀疑原发性微小肝癌或肝癌术后复发性微小肝癌而接受多普勒超声及肝动脉DSA联合碘油CT检查的肝硬化患者影像资料,并与病理结果相对照。结果最终经病理诊断为微小肝癌80例共104个病灶,肝良性结节20例共27个病灶。多普勒超声检出微小肝癌病灶90个,检出率86.54%（90/104）;检出肝良性结节20个（均为肝硬化结节）,检出率74.07%（20/27）。肝动脉DSA联合碘油CT检出微小肝癌病灶96个,检出率92.31%（96/104）;检出肝良性病灶6个（其中无肝硬化结节）,检出率22.22%（6/27）。与肝动脉DSA联合碘油CT检查相比,多普勒超声对微小肝癌的检出率较低（χ~2=9.58,P〈0.05）,而对肝良性结节的检出率较高（χ~2=10.96,P〈0.05）。结论多普勒超声对肝硬化良性结节的检出更具优势,而DSA更有利于检出微小肝癌病灶。

多层CT血管成像诊断肝癌门静脉癌栓

目的 探讨多层CT血管成像 (MSCTA)技术在肝细胞癌 (HCC)合并门静脉癌栓 (PVTT)诊断中的应用价值。方法 对 12 7例行多层螺旋CT动态增强检查的HCC患者 ,分别以最大密度投影法 (MIP)、容积成像法 (VR )和多平面重建 (MPR)技术进行MSCTA成像 ,比较其中 62例HCC合并PVTT患者横断面与CTA图像在PVTT诊断中的差异。结果 MSCTA与横断面图像均能显示全部 43例门脉主干和 /或一级分支癌栓 ;横断面和CTA成像对门脉二级和三级以下分支PVTT以及长度 2cm以下PVTT的显示具有显著统计学差异。结论 MSCTA可明显增加门脉分支癌栓和门脉内较小癌栓的检出率 。

小肝癌的影像学诊断进展

肝细胞癌是世界上最常见的恶性肿瘤之一,对肝癌的早期诊断,亦即小肝癌(SHCC)的诊断并及时治疗是延长肝癌患者生存期的关键.近年来随着各种影像学技术的不断进步,SHCC的检出率在逐年增高.对众多不适合或不愿手术治疗的部分患者而言,SHCC检出率提高不仅意味着可以避免不必要的外科手术,并且可得到早期治疗,提高患者的生存率和预后,极大减轻患者的身心负担.目前以射频消融(RFCA)、微波消融、经皮肝穿瘤内无水乙醇注射及超选择性插管与节段性栓塞(S-TACE)等为代表的介入疗法在SHCC治疗上已经取得了较好的疗效.尤其是射频消融疗法的5年生存率达58.22%,与手术(55.51%)组无差别,使之成为当前和今后SHCC非手术治疗的主要方法.因此,及时准确地对SHCC患者做出诊断,不仅可以减轻患者的痛苦,同时也可延长患者的生存期.本文对国内外有关SHCC的各种影像学诊断进展作一综述如下,以期提高临床医生对SHCC的认识,为SHCC的早期诊断和治疗作出一定贡献.

CT灌注诊断原发性肝癌TACE术后局部肿瘤生长的研究

目的:探讨CT灌注评价原发性肝癌TACE治疗后病灶局部肿瘤生长的能力。方法:选择TACE治疗后CT平扫不能明确有无局部肿瘤生长的病例30例,行CT灌注和DSA检查。以术后1个月为界分成2组,以DSA结果为标准,分析CT灌注对局部肿瘤生长的显示和确认情况。结果:A、B组:CT灌注的敏感性为90.9%、80.0%,特异性为6.7%、71.4%,准确性为40.7%、77.3%。结论:CT灌注对判断TACE术后病灶的局部肿瘤生长有较好的敏感性,术后1个月内不宜应用CT灌注;2个月后可以应用CT灌注进一步判断。

MSCT、MRI、DSA评价HCC TACE术后复发的价值及对比研究

目的:对比分析MSCT、MRI、DSA评价肝癌(HCC)TACE术后复发的价值。方法:HCCTACE术后1月排除HCC病灶残留后,共收集108例HCCTACE术后复发的病例。对其进行临床随访,评价MSCT、MRI和DSA显示HCCTACE术后复发的符合情况。结果:对于①小于0.5cm的复发灶,MSCT与DSA比较其检出率分别为43.5%(40/92)、86.9%(80/92);MSCT与MRI比较其检出率分别为50%(11/22)、90.9%(20/22);MRI与DSA比较其检出率分别为93.1%(27/29)、89.7%(26/29);②对于大于0.5cm小于1cm的复发灶,MSCT与DSA比较其检出率分别为86.5%(45/52)、94.2%(49/52);MSCT与MRI比较其检出率分别为85.0%(17/20)、95.0%(19/20);MRI与DSA比较其检出率分别为100%(24/24)、95.8%(23/24);③对于大于1cm的复发灶,MSCT、MRI和DSA检出率均为100%。结论:①MRI对于显示小于0.5cm的乏血供复发灶比MSCT和DSA敏感,MRI应为首选检查;②DSA显示复发灶的肿瘤染色、血管形态及血管受侵袭情况较MSCT、MRI好;③MSCT显示碘化油聚集的形态较MRI和DSA好;④MRI和DSA显示小于0.5cm的复发灶较MSCT敏感。

64排CT与DSA及C臂CT检出肝癌小病灶的对比

目的比较64排CT、DSA和C臂CT对肝癌小病灶（直径≤3.0 cm）的检出能力。方法对48例肝癌患者先行64排CT扫描,再行肝动脉DSA、TACE和C臂CT扫描。2周内复查CT（碘化油CT）,由3名影像科医师对64排CT、DSA、C臂CT和碘化油CT图像进行分析,计数4种方法对直径≤3.0 cm病灶的显示情况,并以碘化油CT诊断结果作为标准,用McNemar检验比较64排CT、DSA和C臂CT诊断肝癌小病灶的检出率。结果碘化油CT证实48例患者共133个病灶（直径0.5~3.0 cm）,其中64排CT检出55个（55/133,41.35%）,DSA检出110个（110/133,82.70%）,C臂CT检出130个（130/133,97.74%）,三者间两两比较,差异均有统计学意义（P〈0.0001）。根据病灶大小将133个病灶分为3组,A组（直径0.5~1.0 cm）98个病灶,B组（直径1.1~2.0 cm）27个,C组（直径2.1~3.0 cm）8个。64排CT、DSA、C臂CT分别检出A组病灶29、76和95个,B组19、26和27个,C组7、8和8个。结论 C臂CT可提高对肝癌小病灶的检出率。

肝癌治疗后甲胎蛋白增高患者的^(18)F-FDG PET/CT与增强CT对照研究

目的探讨^(18)F-FDG PET/CT在监测肝细胞癌(HCC)治疗后AFP增高患者中肿瘤残余复发及肝外转移的临床价值,并比较^(18)F-FDG PET/CT与增强CT(CECT)在肝内病灶的检出差异。方法回顾性分析54例HCC治疗后AFP增高患者的^(18)F-FDG PET/CT及CECT表现,两者的间隔时间≤2周。结果经病理或影像学、血清AFP水平监测等临床随访(>6个月)证实。结果 45例肝内残余复发,9例肝内未见残余复发;23例肝外转移,其中19例肝内残余复发并肝外转移,4例仅发现肝外转移。^(18)F-FDG PET/CT及CECT对肝内病灶检出的灵敏度、特异度、准确性分别为88.9%(40/45)、57.8%(26/45)、77.8%(7/9)、100%(9/9)、87.0%(47/54)、64.8%(35/54),^(18)F-FDG PET/CT灵敏度及准确性优于CECT(χ~2分别为12.621、8.205,P值均<0.01)。同时^(18)F-FDG PET/CT对肝外转移病灶的灵敏度为100%(23/23)。结论在HCC治疗后AFP增高患者中,^(18)F-FDG PET/CT不但能早期诊断肝内肿瘤残余复发,并能有效地发现肝外转移;而且^(18)F-FDG PET/CT对肝内病灶检出的灵敏度及准确性明显优于CECT。