CT及MR多期动态增强扫描对肝细胞肝癌介入治疗后随诊的对比分析

目的比较多排螺旋CT与MR多期动态增强扫描对肝细胞肝癌（HCC）经肝动脉化疗栓塞（TACE）后肿瘤局灶复发或残存的诊断价值。方法18例结节型HCC患者共38个病灶，TACE介入后22天-11个月分别行多排螺旋CT增强扫描及MRLAVA多期增强扫描，检查平均间隔9天（1～21天）。2位影像诊断医师分别读片，评价肿瘤复发或残存。所有病灶经血管造影、碘油CT、随诊等方法证实。通过计算2种诊断方法的ROC曲线下面积（Az），比较两者诊断的准确性，并评价CT及MR诊断的敏感性差异。结果38个病灶中24个有肿瘤复发或存活，Az值分别为0．948±0．035和0．762±0．074（P〈0．05），MRLAVA诊断的准确性显著高于CT扫描。根据诊断复发的评分标准，MRLAVA诊断存活肿瘤组织的敏感性为87．5％（21／24），CT的敏感性为45．8％（11／24），MRLAVA多期增强扫描的敏感性显著高于CT增强扫描（P〈0．05）。结论在评估肝细胞肝癌TACE治疗后肿瘤残存或复发方面，MR多期增强扫描优于CT增强扫描。

Comparison of contrast-enhanced MR and CT scan for the evaluation of hepatocellular carcinoma post transcatheter arterial chemoenbolization

Purpose To compare the detectability of MR LAVA dynamic enhancement with that of contrast - enhanced CT for the detection of local hepatocellular carcinoma （HCC） recurrence after transcatheter arterial chemoembolization （TACE） using receiver operating characteristic curve （ROC） analysis. Methods Eighteen patients with 38 HCCs underwent MR and spiral CT scan with a mean interval of 9 days （range, 1 -21 days） after 22 days- 11 months of TACE. The enhanced MRI examination were performed with a LAVA technology on a 3 -T unit. Both MRI and CT scan included muhiphase imaging. Two observers independently interpreted the CT and MR images blindly. The diagnostic accuracy of the two techniques was evaluated by comparing the mean area under the ROC curve. The sensitivities and positive predictive value were also compared. Results Among 38 HCCs, 24 were determined local recurrence after TACE. The diagnostic accuracy of MR LAVA was significant higher than that of dynamic CT scan for the local HCCs recurrence. The Az value of MR LAVA was higher than that of dynamic enhanced CT scan （0. 948 ±0. 035 vs 0. 762±0. 074, P 〈0. 05）. The sensitivity of MR LAVA for the detection of recurrence was higher than CT scan （ 87.5 % vs 45.8%, P 〈 0. 05 ）. Conclusion MR LAVA has a high accuracy in detecting the local recurrence of HCC post transcatheter arterial chemoenbolization comparing contrast- enhanced CT scan.