DSA和钆塞酸二钠增强MRI对肝癌术后复发微小病灶诊断的比较研究

目的 对比研究DSA和钆塞酸二钠(Gd-EOB-DTPA)增强MRI对肝癌术后复发微小病灶的诊断效能,评估其诊断价值.方法 回顾性分析2011年9月至2016年3月收治的肝癌术后怀疑有微小复发病灶的患者38例,所有患者均经过DSA、DSA碘油CT和Gd-EOB-DTPA增强MRI检查,对比分析各检查方法诊断的阳性和阴性病例,计算诊断的灵敏度和特异度,所有病例均由2名放射科副主任医师根据诊断标准独立诊断,以手术或者穿刺病理结果以及至少6个月随访作为最终诊断依据.结果 38例患者,共发现47个病灶,病灶直径0.5～2.0 cm,平均(1.2±0.8)cm,其中41个病灶证实为复发微小肝癌,22个有病理结果,其余19个病灶经过随访证实.6个病灶为非肝癌病灶,全部由随访证实.所有病灶中,常规DSA诊断的灵敏度为73.2％,特异度为80.0％.DSA结合碘油CT诊断的灵敏度为90.2％,特异度为100％.Gd-EOB-DTPA增强MRI诊断的灵敏度为95.1％,特异度为100％.诊断效能之间统计学分析显示,常规DSA-DSA碘油CT以及常规DSA-MRI之间差异有统计学意义(P＜0.05),碘油CT与MRI间差异无统计学意义(P＞0.05).结论 对肝癌术后的微小肝癌结节,DSA联合碘油CT的诊断效能和Gd-EOB-DTPA增强MRI类似,对于临床上不适合做MRI的患者,可以考虑采用DSA联合碘油CT作为替代检查手段.

Comparative study of DSA vs Gd-EOB-DTPA-enhanced MRI in diagnosing postoperative recurrent tiny HCC lesions

Objective To compare the diagnostic value of DSA with that of Gd-EOB-DTPA-enhanced MRI for postoperative recurrent tiny hepatocellular carcinoma (HCC) lesions.Methods The clinical data of a total of 38 patients,who were admitted to authors' hospital during the period from September 2011 to March 2016 as clinically they were suspected to have postoperative recurrent tiny HCC lesions,were retrospectively analyzed.DSA,DSA plus lipiodol CT scan and Gd-EOB-DTPA-enhanced MRI were performed in all patients.The positive and negative diagnosis rates were compared among different examination methods,the diagnostic sensitivity and specificity were calculated.The imaging diagnosis of each patient was made by two associationchief radiologists independently,both the pathological findings from surgery or puncture biopsy and the 6-month follow-up results were taken as the final diagnosis basis.Results A total of 47 lesions were detected in the 38 patients.The diameter of the lesions was 0.5-2.0 cm,with an average of (1.2+0.8) cm.Of the 47 lesions,41 were proved to be recurrent tiny HCC lesions.Among the 41 lesions,22 had pathological evidence,and the remaining 19 lesions were confirmed through clinical follow-up.Six lesions were non-HCC focus,which were proved by clinical follow-up.For all lesions,the diagnostic sensitivity and specificity were 72.2％ and 80.0％ respectively by conventional DSA,which were 90.2％ and 100％ respectively by DSA plus lipiodol CT scan,and were 95.1％ and 100％ respectively by Gd-EOB-DTPA-enhanced MRI.Statistical analysis indicated that significant differences in diagnostic sensitivity and specificity existed between conventional DSA and DSA plus lipiodol CT scan as well as between conventional DSA and Gd-EOB-DTPA-enhanced MRI (P＜0.05),while the differences in diagnostic sensitivity and specificity between DSA plus lipiodol CT scan and Gd-EOB-DTPA-enhanced MRI were not statistically significant (P＞0.05).Conclusion For the detection of postoperative recurrent tiny HCC lesions,DSA plus lipiodol CT scan has quite the same diagnostic value as Gd-EOB-DTPA-enhanced MRI does.For patients who are not suitable to receive MRI examination,the use of DSA plus lipiodol CT scan,as an alternative means of inspection,should be taken into consideration.