DCE-MRI联合CT增强扫描在肝细胞癌TACE治疗效果评估中的价值

摘要/Abstract

摘要： 目的探究磁共振动态对比增强(DCE-MRI)联合电子计算机断层扫描(CT)增强扫描在肝细胞癌经导管肝动脉化疗栓塞术(TACE)治疗后病灶残留或复发中评估效果。方法将淮安市第一人民医院2020年4月—2023年1月收治的89例肝细胞癌患者纳入研究,TACE治疗后1～2个月以数字减影血管造影为金标准,同时行DCE-MRI、CT增强扫描检查,分析DCE-MRI、CT增强扫描结果单一及联合对肝细胞癌TACE治疗后病灶残留或复发的评估效能。结果数字减影血管造影检查结果显示,89例患者中共检出肝癌病灶116个,经TACE治疗后病灶残留或复发74个,完全灭活病灶42个。DCE-MRI、增强CT分别检出病灶残留或复发76个、77个,完全灭活病灶40个、39个。ROC分析得出,DCE-MRI、增强CT单一及联合诊断病灶残留或复发的灵敏度分别为90.48%、85.71%、92.86%,特异度分别为97.30%、95.95%、97.30%,曲线下面积(AUC)分别为0.939、0.908、0.951。DCE-MRI、增强CT单一及联合诊断原发性肝细胞TACE治疗后病灶残留或复发与数字减影血管造影诊断结果的Kappa值分别为0.887、0.829、0.906。结论 DCE-MRI联合CT增强扫描可用于评估肝细胞癌TACE治疗后病灶残留或复发,且效能良好。

关键词: 肝细胞癌, 经导管肝动脉化疗栓塞术, 磁共振动态对比增强, 增强CT

Abstract: Objective To explore the effect of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) combined with enhanced electronic computed tomography (CT) in evaluating the residual or recurrent lesions of primary hepatocellular carcinoma after transcatheter hepatic arterial chemoembolization (TACE). Methods Eighty-nine patients with primary hepatocellular carcinoma admitted to Huai’an First People’s Hospital from April 2020 to January 2023 were included in the study. One to two months after TACE treatment, digital subtraction angiography was taken as the gold standard, and DCE-MRI and CT enhanced scanning were performed in all patients at the same time. Results By digital subtraction angiography, a total of 116 liver cancer lesions were detected in 89 patients. After TACE treatment, there were 74 lesions remained or recurred, and 42 lesions were completely inactivated. DCE-MRI and contrast-enhanced CT detected 76 and 77 residual or recurrent lesions, and 40 and 39 completely inactivated lesions, respectively. Receiver operating curve (ROC) analysis showed that the sensitivities of DCE-MRI and contrast-enhanced CT for single and combined diagnosis of residual or recurrent lesions were 90.48%, 85.71%, and 92.86%, with the specificities of 97.30%, 95.95%, and 97.30%, and the areas under the curve (AUC) of 0.939, 0.908, and 0.951, respectively. The Kappa values of residual or recurrent lesions after TACE treatment in primary hepatocellular carcinoma diagnosed by DCE-MRI and enhanced CT alone and in combination with digital subtraction angiography were 0.887, 0.829, and 0.906, respectively. Conclusion DCE-MRI combined with CT enhanced scan can be used to evaluate the residual or recurrent lesions of primary hepatocellular carcinoma after TACE treatment,with a good efficacy.

Key words: Hepatocellular carcinoma, Primary, Transcatheter hepatic arterial chemoembolization, Dynamic contrast enhancement of magnetic resonance, Enhanced CT

杨紫郡, 杨佳欣, 郭莉莉. DCE-MRI联合CT增强扫描在肝细胞癌TACE治疗效果评估中的价值[J]. 肝脏, 2024, 29(9): 1060-1063.

YANG Zi-jun, YANG Jia-xin, GUO Li-li. The value of DCE-MRI combined with enhanced CT scan in evaluating the treatment effect of TACE on patients with primary hepatocellular carcinoma[J]. Chinese Hepatolgy, 2024, 29(9): 1060-1063.

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