超声、CT、MRI对肝炎后肝硬化继发肝癌患者介入治疗术后临床预后的评估价值探究
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摘要
目的分析超声、CT、MRI对肝炎后肝硬化继发肝癌患者介入治疗术后临床预后的评估价值。方法选取2014年6月至2018年6月本院收治的91例接受介入治疗的肝炎后肝硬化继发肝癌患者为研究对象,以数字减影血管造影(digital subtraction angiography,DSA)检查结果为金标准,探讨术后3～5周超声、CT及MRI对患者肿瘤活性的评估价值。结果 91例患者共检出病灶110枚,均经DSA检查结合临床随访确诊,其中DSA检出活性病灶37枚,检出率为33.64%;以DSA检查结果为金标准,超声、CT及MRI对活性病灶检出率分别为45.95%、72.97%、89.19%。超声和CT对肝炎后肝硬化继发肝癌患者介入治疗术后活性病灶的检出率均低于DSA(P_均<0.05),MRI和DSA对活性病灶检出率比较无显著差异(P> 0.05)。以DSA检查结果为金标准,超声、CT及MRI评估患者肿瘤存活的灵敏度分别为40.54%、54.05%、78.38%,特异度分别为97.18%、90.41%、94.52%,其接受者操作特征曲线下面积分别为0.906、0.824、0.515。结论 MRI能够为肝炎后肝硬化继发肝癌患者介入治疗术后肿瘤活性评估提供可靠参考,结合超声、CT能够提供更为全面的病灶信息,指导后续治疗方案的制订。
Objective To analyze the value of ultrasonography, CT and MRI in evaluating the clinical prognosis of patients with hepatocellular carcinoma secondary to post-hepatitis cirrhosis after interventional therapy, and to summarize the application experience. Method 91 patients with hepatocellular carcinoma secondary to post-hepatitis cirrhosis treated by interventional therapy in our hospital from June 2014 to June 2018 were selected as the research objects. The value of ultrasound, CT and MRI in evaluating the tumor activity of patients after 3 ～ 5 weeks of operation was analyzed based on the results of digital subtraction angiography(DSA). Result A total of 110 lesions were detected in 91 patients. All lesions were confirmed by DSA combined with clinical follow-up. 37 active lesions were detected by DSA 3 ～ 5 weeks after operation, with a detection rate of 33.64%. With DSA as the gold standard, the detection rates of active lesions by ultrasonography, CT and MRI were 45.95%, 72.97% and 89.19%, respectively.The detection rate of active lesions in hepatocellular carcinoma patients after interventional therapy by ultrasonography and CT was lower than that by DSA(P_(all)< 0.05). There was no signi?cant difference in the detection rate of active lesions between MRI and DSA(P > 0.05). With DSA as the gold standard, the sensitivity, speci?city of ultrasonography, CT and MRI were 40.54%, 54.05%,78.38% and 97.18%, 90.41%, 94.52% respectively. The receiver operating characteristic(ROC) curves were 0.906, 0.824 and 0.515 respectively. Conclusion MRI can provide a reliable reference for evaluating the tumor activity of patients with hepatocellular carcinoma secondary to post-hepatitis cirrhosis after interventional therapy. Combined with ultrasonography and CT, it can provide more comprehensive lesion information and guide the formulation of follow-up treatment plan.
Objective To analyze the value of ultrasonography, CT and MRI in evaluating the clinical prognosis of patients with hepatocellular carcinoma secondary to post-hepatitis cirrhosis after interventional therapy, and to summarize the application experience. Method 91 patients with hepatocellular carcinoma secondary to post-hepatitis cirrhosis treated by interventional therapy in our hospital from June 2014 to June 2018 were selected as the research objects. The value of ultrasound, CT and MRI in evaluating the tumor activity of patients after 3 ～ 5 weeks of operation was analyzed based on the results of digital subtraction angiography(DSA). Result A total of 110 lesions were detected in 91 patients. All lesions were confirmed by DSA combined with clinical follow-up. 37 active lesions were detected by DSA 3 ～ 5 weeks after operation, with a detection rate of 33.64%. With DSA as the gold standard, the detection rates of active lesions by ultrasonography, CT and MRI were 45.95%, 72.97% and 89.19%, respectively.The detection rate of active lesions in hepatocellular carcinoma patients after interventional therapy by ultrasonography and CT was lower than that by DSA(P_(all)< 0.05). There was no signi?cant difference in the detection rate of active lesions between MRI and DSA(P > 0.05). With DSA as the gold standard, the sensitivity, speci?city of ultrasonography, CT and MRI were 40.54%, 54.05%,78.38% and 97.18%, 90.41%, 94.52% respectively. The receiver operating characteristic(ROC) curves were 0.906, 0.824 and 0.515 respectively. Conclusion MRI can provide a reliable reference for evaluating the tumor activity of patients with hepatocellular carcinoma secondary to post-hepatitis cirrhosis after interventional therapy. Combined with ultrasonography and CT, it can provide more comprehensive lesion information and guide the formulation of follow-up treatment plan.
引文
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[17]孙伟,李忱瑞.CT对肝癌TACE术后疗效及其残灶活性的评估作用分析[J].中国CT和MRI杂志,2015,13(5):77-79.
[18]Kuang X,Ye J,Xie Z,et al.Adjuvant transarterial chemoe mbolization to improve the prognosis of hepatocellular carcinoma following curative resection[J].Oncol Lett,2018,16(4):4937-4944.
[2]苏赞瑞,黄运福,林建军,等.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[J].介入放射学杂志,2017,26(6):559-563.
[3]吴名凤,沈智勇,蒋晓娟.超声评估原发性肝癌患者预后的Cox比例风险回归模型分析[J].中华实用诊断与治疗杂志,2015,29(2):204-205.
[4]敖劲,曾令雯,刘衡,等.原发性肝癌DSA表现与TACE疗效的关系分析[J].中国普通外科杂志,2016,25(1):51-56.
[5]Tang A,Bashir MR,Corwin MT,et al.Evidence Supporting LI-RADS Major Features for CT-and MR Imaging-based Diagnosis of Hepatocellular Carcinoma:A Systematic Review[J].Radiology,2017,286(1):29-48.
[6]Yang B,Li CL,Guo W,et al.Intra-arterial ethanol embolization augments response to TACE for treatment of HCC with portal venous tumor thrombus[J].BMC Cancer,2018,18(1):101.
[7]Xu Z,Yu C,Wang S,et al.Transcatheter arterial chemoembolization as an examination method for hepatocellular carcinoma undetected by B-mode ultrasound,computed tomography and digital subtratcion angiography:A case report[J].Oncol Lett,2015,10(3):1759-1762.
[8]冯晓波,刘玉林,陈宪,等.CT对原发性肝癌TACE疗效评价的mRECIST和RECIST对比研究[J].临床放射学杂志,2012,31(9):1334-1337.
[9]徐民,程雪,赵中伟,等.超声、CT、MRI及DSA在肝癌介入综合治疗术后肿瘤活性评估中的对比价值研究[J].介入放射学杂志,2018,27(4):363-366.
[10]黄卫民,徐辉,汪继辉.CT增强扫描和DSA检测原发性肝癌TACE术后肿瘤残留及新发病灶[J].中国CT和MRI杂志,2016,14(9):77-79.
[11]Liu FY,Li X,Yuan HJ,et al.Angio-Computed Tomograph-Guided Immediate Lipiodol Computed Tomograph for Diag nosis of Small Hepatocellular Carcinoma Lesions during Transa rterial Chemoembolization[J].Chin Med(Engl),2018,131(20):2410-2416.
[12]Fang CH,Tao HS,Yang J,et al.Impact of three-dimensional reconstruction technique in the operation planning of centrally located hepatocellular carcinoma[J].J Am Coll Surg,2015,220(1):28-37.
[13]蒋明,胡鸿涛.超声造影、增强CT扫描及MRI在评估肝癌介入治疗疗效中的应用比较[J].中国CT和MRI杂志,2017,15(8):88-90.
[14]Tacher V,Radaelli A,Lin MD,et al.How I do it:cone-beam CT during transarterial chemoembolization for liver cancer[J].Radiology,2015,274(2):320-334.
[15]斯兴无,周红俐,陈华平,等.MRI与CT对原发性肝癌TACE术后的疗效评估[J].西部医学,2017,29(8):1150-1153.
[16]Lu L,Xu K,Han C,et al.Comparison of 3.0 T MRI with 3DLAVA sequence and digital subtraction angiography for the assessment of accessory hepatic veins in Budd-Chiari syndrome[J].J Magn Reson Imaging,2017,45(2):401-409.
[17]孙伟,李忱瑞.CT对肝癌TACE术后疗效及其残灶活性的评估作用分析[J].中国CT和MRI杂志,2015,13(5):77-79.
[18]Kuang X,Ye J,Xie Z,et al.Adjuvant transarterial chemoe mbolization to improve the prognosis of hepatocellular carcinoma following curative resection[J].Oncol Lett,2018,16(4):4937-4944.