非刚性三维校正肝脏MR动态减影技术应用于肝细胞癌经导管动脉内化疗栓塞术后疗效评估的研究

目的对比CT增强和非刚性三维校正肝脏MR增强动态减影技术对肝细胞癌(HCC)经导管动脉内化疗栓塞术(TACE)后肿瘤血供判断能力的差异,探讨非刚性三维校正肝脏MR增强动态减影技术的临床应用价值。 方法收集HCC患者TACE术后并再次需进行TACE治疗的病例21例,所有患者均行CT平扫及增强扫描、MR平扫及动态增强扫描,MR扫描采用非刚性三维校正动态减影技术。分别在CT和MR增强非刚性三维校正减影图像上对病灶血供情况评估统计,以再次TACE术前的DSA评价结合结节前后的体积变化综合考虑作为金标准,比较两种检查方式对碘油沉积病灶血供评价的能力。 结果共分析126个碘油沉积灶,在对碘油沉积灶血供的判断中,CT与DSA检查诊断结果不一致(P<0.001),MR和DSA检查诊断结果一致(P=0.375);在结节的血供判断方面,CT/MR对肝结节血供判断的敏感度、特异度、假阳性率、假阴性率、正确指数、阳性似然比、阴性似然比、符合率分别为6.2%/99.1%、76.0%/69.2%、23.1%/30.8%、93.8%/0.9%、0.02/0.68、0.27/3.22、1.22/0.01、13.5%/96.0%。 结论相对CT检查,非刚性三维校正肝脏MR动态减影技术在HCC患者TACE治疗后疗效评估中有明显的诊断优势,具有重要的临床应用价值。

Application of non rigid 3D-registration for accurate subtraction of dynamic liver MR imaging technique in tumor blood supply assessment for hepatocellular carcinoma after transarterial chemoembolization

ObjectiveTo compare the capacity between contrast-enhanced computed tomography (CT) and non rigid 3D-registration for accurate subtraction of dynamic liver magnetic resonance imaging (MRI) in tumor blood supply assessment for hepatocellular carcinoma(HCC) after transarterial chemoembolization(TACE), and to evaluate the clinical value of 3D-registration for accurate subtraction of dynamic liver magnetic resonance imaging(MRI). MethodsTwenty-one patients with HCC followed TACE therapy were included in the study. All the patients underwent both contrast-enhanced CT and MRI. MRI examination used non rigid 3D-registration for accurate subtraction of dynamic liver imaging technique. And the assessment statistics of these patients’ blood supply information of all the lesions both in the CT images and the MRI image that dealt with non rigid 3D-registration were collected. Digital subtraction angiography (DSA) assessment before next TACE therapy and volume changes of the nodule were considered as the golden standard to compare the ability of tumor blood supply assessment of the two methods. ResultsOne hundred and twenty-six lipiodol accumulation lesions were analyzed. The diagnostic accuracy was different between CT and DSA (P<0.001) while no difference between MR and DSA (P=0.375) of all the lipiodol accumulation lesion’s blood supply. In the assessment of lesion’s blood supply, the sensitivity, specificity, false positive rate, false negative rate, correct indices, positive likelihood ratio, negative likelihood ratio and coincidence rate of CT/MR were 6.2%/99.1%, 76.0%/69.2%, 23.1%/30.8%, 93.8%/0.9%, 0.02/0.68, 0.27/3.22, 1.22/0.01, 13.5%/96.0%. ConclusionNon rigid 3D-registration for accurate subtraction of dynamic liver magnetic resonance imaging is superior in tumor blood supply assessment for HCC after TACE than CT and has important clinical value.