CT联合MRI评估原发性肝癌患者的介入及分子靶向治疗效果

目的探讨CT及MRI评估原发性肝癌（HCC）患者介入及分子靶向治疗效果的价值。方法回顾性选取我院于2017年1月~2019年1月收治的80例中晚期HCC患者作为研究对象，患者均行肝动脉化疗栓塞术（TACE）治疗+索拉非尼治疗，3月后均行CT、MRI和数字减影血管造影（DSA）检查。比较CT联合MRI与单独CT检查HCC患者治疗后3月的临床有效例数、有效率，并以DSA检查结果为金标准，计算两种检查方法的敏感度、特异度、准确率和kappa值，并比较两种检查方法对患者治疗后的残余和复发病灶检出情况。结果经TACE+索拉非尼治疗后3月，DSA显示总目标病灶数由98个减少至86个，病灶明显缩小，临床疾病控制患者64例，无效患者16例，疾病控制率80.00%;共检出残留和复发病灶共82个，其中Ⅰ型、Ⅱ型、Ⅲ型、Ⅳ型碘油沉积残留和复发病灶数分别为9、18、42、17个。CT联合MRI检出患者治疗后Ⅱ型以及总碘油沉积残留、复发病灶个数均大于CT检查（P < 0.05）; CT联合MRI评估TACE+索拉非尼治疗HCC患者疗效的灵敏度95.31%高于单独CT检查的84.38%（P < 0.05），且CT联合MRI评估临床疗效与DSA检查的Kappa值为0.809，且大于单独CT评估与DSA检查的Kappa值（0.605）。结论TACE+索拉非尼治疗HCC患者3月后具有较好的临床疗效，且相比单独CT检查，CT联合MRI更有利于患者治疗后残留和复发灶的检出，同时对于患者治疗后3月疗效的评估具有更高的灵敏度和应用价值。 

Value of CT and MRI in evaluating the effects of intervention and molecular targeted therapy on patients with primary hepatocellular carcinoma

ObjectiveTo explore the value of CT and MRI in evaluating the effects of intervention and molecular targeted therapy on patients with primary hepatocellular carcinoma (HCC).MethodsA total of 80 patients with advanced HCC admitted to the hospital from January 2017 to January 2019 were retrospectively enrolled as the research objects. All patients underwent hepatic artery chemoembolization (TACE) and sorafenib therapy, and CT, MRI and digital subtraction angiography (DSA) were performed after 3 months. The number of clinically effective cases and response rate were compared after 3 months treatment by CT combined MRI and CT alone. Taking DSA results as the golden standard, the sensitivity, specificity, accuracy and kappa values of the two methods were calculated. The detection situations of residual and recurrence lesions were compared after treatment by the two methods.ResultsAfter 3 months of TACE and sorafenib treatment, DSA showed that the total number of target lesions decreased from 98 to 86, the lesions significantly reduced There were 64 clinical disease control patients and 16 ineffective patients, with 80.00% disease control rate. There were 82 residual and recurrence lesions. Among them, there were 9, 18, 42 and 17 residual and recurrence lesions of type I, II, III and IV iodized oil deposition, respectively. The detected number of type II iodized oil deposition and recurrence lesions by CT combined with MRI was more than that by CT (P < 0.05). The sensitivity of CT combined with MRI for evaluating the curative effect of TACE and sorafenib on HCC patients was higher than that of CT examination alone (95.31% vs 84.38%, P < 0.05). Kappa value of CT combined with MRI for evaluating clinical curative effect and DSA examination was 0.809, which was greater than that of CT alone (0.605).ConclusionThe clinical curative effect of TACE and sorafenib is good on HCC patients 3 months later. Compared with CT alone, CT combined with MRI is more conducive to detecting residual and recurrent lesions after treatment, which has of higher sensitivity and application value in evaluating curative effect after 3 months of treatment.