四种影像学检查评价原发性肝癌患者介入治疗的疗效

目的 探讨超声造影、螺旋CT、MRI在原发性肝癌（PLC）经导管肝动脉化疗栓塞术（TACE）治疗后近期疗效评估的价值及意义，为临床在PLC介入治疗术后复查方式选择提供经验依据。方法 选择2010年6月至2015年6月在郑州大学第一附属医院就诊的临床资料及影像学资料完整的PLC行TACE治疗患者45例，术后复查行数字减影血管造影（DSA）、超声造影、螺旋CT和MRI检查，以DSA为金标准，对比分析三种影像学检查对TACE治疗后肿瘤残留及新发病灶检出的灵敏度Se）和特异度（Sp）。结果 在小于5 cm病灶的诊断中，MRI（Se=92.3％,Sp=88.5％）和超声造影（Se=89.4％，Sp=84.6％）的灵敏度及特异度显著高于螺旋CT（Se=88.7％，Sp=80.8％），差异具有统计学意义（P＜0.05），在大于5 cm的病灶诊断中，三种影像学检查的效能无统计学差异（P＞0.05）；在诊断病灶供血动脉来源方面，三种影像学检查的效能差异无显著性统计学差异（P＞0.05）；在诊断门静脉癌栓方面，螺旋CT的准确性（92.2％）显著高于MRI（90.8％）或超声造影（90.5％），差异具有统计学意义（P＜0.05）；在观察病灶强化预示复发方面，超声造影（95％）、MRI（96.4％）的特异度显著优于螺旋CT（93.7％），且其差异具有统计学意义（P＜0.05）。结论 超声造影检查可作为螺旋CT和MRI之外评估PLC患者介入治疗后肿瘤残留及新发病灶检出的另一有效影像学检查，具有较大的临床应用价值。

Evaluation of tumor recurrence in patients with primary liver cancer after TACE by imaging examination

Objective To investigate the evaluation of tumor recurrence in patients with primary liver cancer after TACE by ultasonography，spiral CT and MRI.Methods An retrospective study of clinical data in 45 patients with PLC was conducted in this study. All patients were checked-up by DSA，ultasonography，spiral CT，and MRI after TACE. The DSA result was acted as the gold standard to compare the diagnostic efficacies of other three imaging examination.Results In displaying small lesions less than 5 cm，the sensitivity and specificity of MRI （Se=92.3％，Sp=88.5％） and ultasonography （Se=89.4％，Sp=84.6％） were higher than those by spiral CT（Se=88.7％，Sp=80.8％，respectively），the difference were statistically significant （P<0.05）；In displaying large lesions greater than 5 cm，the differences of diagnostic values among the three imaging examinations had no statistical difference（P＞0.05）；In finding the blood supply of the neoplasmas，the three imaging examination had no statistical difference（P>0.05）；In showing portal venous tumor emboli foramtion，the 92.2％ accuracy of spiral CT was higher than 90.8％ by MR，or 90.5％ by ultasonography，and the differences were statistically significant（P<0.05）；In displaying the lesions strengthening，the specificity（95％） of ultasonography and 96.4％ of MRI were superior to 93.7％ of spiral CT.Conclusion Ultrasound examination might be an alternative approaches to evaluate the recurrence of tumors in patients with PLC after TACE.