超声造影、增强CT扫描及MRI在评估肝癌介入治疗疗效中的应用比较

目的探讨超声造影(Contrastenhanced ultrasound,CEUS)、增强CT扫描及MRI在评估肝癌介入治疗疗效中的应用价值。方法收集2013年3月-2015年7月我院收治的90例行介入治疗肝癌患者为研究对象,介入治疗前均行CEUS检查,介入治疗后分别行CEUS、增强CT扫描及MRI检查,并以数字减影血管造影(DSA)为金标准,对各类检查结果进行对比分析。结果 (1)治疗前90例患者行CEUS检查,共检出120个病灶(动脉期均匀增强95个,动脉期不均匀强化25个);介入治疗后1个月,DSA检出阳性、阴性、尚未确定病灶各76、37、7个;CEUS检出阳性、阴性、尚未确定病灶各75、40、5个;增强CT扫描检出阳性、阴性、尚未确定病灶各58、40、12个;经MRI检出阳性、阴性、尚未确定病灶各65、45、10个,CEUS与DSA评价肝癌介入治疗疗效的一致性较好(Kappa≥0.75),而增强CT扫描及MRI与DSA检查结果的一致性较差(Kappa0.40)。(3)以DSA检查结果为金标准,CEUS诊断介入治疗阳性病灶的灵敏度98.68%(75/76)、总符合率95.00%(114/120)较增强CT扫描及MRI诊断效率显著高,假阴性率2.70%(1/37)显著低(P0.05)。结论 CEUS在诊断肝癌介入治疗后阳性病灶灵敏度、与DSA总符合率较增强CT扫描及MRI更高,而假阴性率更低,值得推广应用。

Comparison of the Application of Contrast-enhanced Ultrasound,Enhanced CT Scan and MRI in Evaluating the Efficacy of Interventional Therapy for Hepatocellular Carcinoma

Objective To investigate the application value of contrast-enhanced ultrasound (CEUS), enhanced CT scan and MRI in evaluating the efficacy of interventional therapy for hepatocellular carcinoma (HCC).Methods From March 2013 to July 2015, 90 cases with HCC who received interventional therapy in our hospital were enrolled in the study. All patients were examined by CEUS before interventional therapy and they were examined by CEUS, enhanced CT and MRI scan after interventional therapy. With the results of digital subtraction angiography (DSA) as the golden standard, the detection results were compared.Results Before treatment, 90 patients were examined by CEUS, and a total of 120 lesions (homogeneous enhancement in 95 lesions and inhomogeneous enhancement in 25 lesions) were detected. One month after interventional therapy, the numbers of positive, negative and uncertain lesions detected by DSA were 76, 37 and 7,by CEUS were 75, 40 and 5, by enhanced CT scan were 58, 40 and 12, and by MRI were 65, 45 and 10. The consistency of CEUS and DSA in evaluating the efficacy was better (Kappa≥0.75), while the consistency of enhanced CT scan and MRI with the results of DSA was poor (Kappa<0.40). With the results of DSA as the golden standard, the sensitivity and total coincidence rate of CEUS in the diagnosis of positive lesions were 98.68%(75/76) and 95.00% (114/120) which were higher than those of enhanced CT scan and MRI while the false negative rate 2.70% (1/37)] was significantly lower (P<0.05). Conclusion The sensitivity and coincidence rate with DSA of CEUS in the diagnosis of positive lesions after interventional therapy are higher than those of enhanced CT scan and MRI, while the false negative rate is lower.