磁共振扩散加权成像与螺旋CT分别联合血清AFP对早期原发性肝癌诊断价值的对比分析
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摘要
目的探讨磁共振扩散加权成像与螺旋CT分别联合血清甲胎蛋白(AFP)对早期原发性肝癌的诊断价值。方法选取200例疑似原发性肝癌患者,分别进行磁共振扩散加权成像联合血清AFP检测以及螺旋CT联合血清AFP检测。以组织病理活检为金标准,观察2种检测方式对早期原发性肝癌患者的特异度、灵敏度、阳性预测值、阳性似然比以及诊断准确率。结果经病理检测后,200例疑似原发性肝癌患者中有180例确诊为原发性肝癌患者,DWI+血清AFP对原发性肝癌阳性检出率明显高于CT+血清AFP检测阳性检出率[(90. 56%) vs(82. 22%)(χ~2=5. 315,P=0. 021)],DWI+血清AFP检测特异度明显高于CT+血清AFP检测特异度[(80. 00%) vs(45. 00%)(χ~2=5. 227,P=0. 022)]。DWI+血清AFP检测后对原发性肝癌的特异度、灵敏度、阳性预测值、阳性似然比、诊断准确率分别为80. 00%、90. 56%、97. 60%、4. 78、89. 50%,CT+血清AFP检测后对原发性肝癌的特异度、灵敏度、阳性预测值、阳性似然比、诊断准确率分别为45. 00%、82. 22%、93. 08%、1. 49、78. 50%,DWI+血清AFP检测的各结果明显优于CT+血清AFP检测。结论磁共振扩散加权成像联合血清AFP水平对HCC的临床诊断价值显著高于螺旋CT,其在HCC的早期诊断中具有较高的灵敏度、特异度以及阳性似然度,对HCC早期发病的临床诊断具有重要参考价值。
Objective To compare the diagnostic value of magnetic resonance diffusion weighted imaging and spiral CT combined with serum alpha-fetoprotein( AFP) in the diagnosis of primary liver cancer,and to improve the diagnosis of early primary liver cancer. Methods A total of 200 patients with suspected primary liver cancer were enrolled in our hospital from January 2014 to February 2016. The patients were examined by magnetic resonance diffusion weighted imaging combined with serum AFP and spiral CT combined with serum AFP. Compared with the gold standard,two kinds of detection methods were observed for early primary liver cancer Patient specificity,sensitivity,positive predictive value,positive likelihood ratio,and diagnostic accuracy. Results The positive rate of AFP in DWI + serum was significantly higher than that in patients with primary hepatocellular carcinoma( P < 0. 05). The positive rate of AFP in DWI + serum was significantly higher than that in CT + serum( P < 0. 05)( 80. 2%)( χ~2= 5. 315,P = 0. 021) ],the specificity of DWI + serum AFP was significantly higher than that of CT + serum AFP [( 80. 00%) vs( 45. 00%)( χ~2= 5. 227,P = 0. 022). The specificity,sensitivity,positive predictive value and positive likelihood ratio of DWI + serum AFP were 80. 00%,90. 56%,97. 60%,4. 78,89. 50%,CT + serum AFP The specificity,sensitivity,positive predictive value and positive likelihood ratio of the primary hepatocellular carcinoma were 45. 00%,82. 22%,93. 08%,1. 49 and 78. 50% respectively. The results of DWI + serum AFP were significantly better Detection of CT + serum AFP. Conclusion The clinical diagnostic value of magnetic resonance diffusion weighted imaging combined with serum AFP level in HCC is significantly higher than that in spiral CT,which has high sensitivity,specificity and positive likelihood of the early diagnosis of HCC. Diagnosis has important reference values.
Objective To compare the diagnostic value of magnetic resonance diffusion weighted imaging and spiral CT combined with serum alpha-fetoprotein( AFP) in the diagnosis of primary liver cancer,and to improve the diagnosis of early primary liver cancer. Methods A total of 200 patients with suspected primary liver cancer were enrolled in our hospital from January 2014 to February 2016. The patients were examined by magnetic resonance diffusion weighted imaging combined with serum AFP and spiral CT combined with serum AFP. Compared with the gold standard,two kinds of detection methods were observed for early primary liver cancer Patient specificity,sensitivity,positive predictive value,positive likelihood ratio,and diagnostic accuracy. Results The positive rate of AFP in DWI + serum was significantly higher than that in patients with primary hepatocellular carcinoma( P < 0. 05). The positive rate of AFP in DWI + serum was significantly higher than that in CT + serum( P < 0. 05)( 80. 2%)( χ~2= 5. 315,P = 0. 021) ],the specificity of DWI + serum AFP was significantly higher than that of CT + serum AFP [( 80. 00%) vs( 45. 00%)( χ~2= 5. 227,P = 0. 022). The specificity,sensitivity,positive predictive value and positive likelihood ratio of DWI + serum AFP were 80. 00%,90. 56%,97. 60%,4. 78,89. 50%,CT + serum AFP The specificity,sensitivity,positive predictive value and positive likelihood ratio of the primary hepatocellular carcinoma were 45. 00%,82. 22%,93. 08%,1. 49 and 78. 50% respectively. The results of DWI + serum AFP were significantly better Detection of CT + serum AFP. Conclusion The clinical diagnostic value of magnetic resonance diffusion weighted imaging combined with serum AFP level in HCC is significantly higher than that in spiral CT,which has high sensitivity,specificity and positive likelihood of the early diagnosis of HCC. Diagnosis has important reference values.
引文
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[13]赵凯.1.5T超导型全身MRI弥散加权成像用于诊断肝脏良恶性病变临床价值分析[J].中国CT和MRI杂志,2015,13(4):66-69.
[14]陈娟,尹化斌.磁共振扩散加权成像在肝脏疾病中的应用[J].临床肝胆病杂志,2015,31(1):139-142.
[15]Achiam MP,Logager VB,Skjoldbye B,et al.Preoperative CT versus diffusion weighted magnetic resonance imaging of the liver in patients with rectal cancer;a prospective randomized trial[J].Peer J,2016,4(12):1532.
[16]宋承东,曾光,黄鼎祥,等.磁共振弥散加权成像联合LAVA技术诊断肝脏占位性病变的临床价值[J].实用肝脏病杂志,2015,18(2):201-203.
[17]Kang TW,Kim SH,Jang KM,et al.Gastrointestinal stromal tumours:Correlation of modified NIH risk stratification with diffusion-weighted MR imaging as an imaging biomarker[J].European J Radiol,2015,84(1):33-40.
[18]曹丽荣.肿瘤标志物联合甲胎蛋白检测方法在原发性肝癌患者中的诊断研究[J].中国药物与临床,2017,17(6):264-265.
[19]崔灿,牛国平.肿瘤标志物联合检测对原发性肝癌的诊断价值[J].现代肿瘤医学,2015,23(9):1262-1265.
[20]朱波,肖亚雄,彭宇生,等.GP73和AFP联合检测在原发性肝癌中的诊断价值[J].检验医学与临床,2016,13(5):595-596.
[2]赵荣荣,邓永东,袁宏.236例原发性肝癌患者流行病学及临床特点分析[J].临床肝胆病杂志,2016,32(8):1538-1542.
[3]李佳红,付娜,牛学敏,等.573例原发性肝癌病因及临床特点分析[J].实用肝脏病杂志,2015,18(4):399-402.
[4]钟玉凤,唐作华.磁共振特异性对比剂在原发性肝癌诊断中的应用[J].放射学实践,2015,30(10):1056-1058.
[5]古今,王雨,罗丽.原发性肝癌磁共振与超声成像特点及诊断价值分析[J].中国CT和MRI杂志,2016,14(12):71-73.
[6]冯静.DWI联合常规磁共振成像在原发性肝癌治疗后随访中应用研究[J].中国CT和MRI杂志,2017,15(5):100-102.
[7]王延峰,李南阳,任雅玲,等.GPC3和AFP联合检测对原发性肝癌的诊断价值[J].中国实验诊断学,2015,19(3):366-368.
[8]赵书云,赵洁,刘杰,等.血清胰蛋白酶原-2对肝细胞癌的诊断价值[J].解放军医药杂志,2015,27(2):4-7.
[9]Cercueil JP,Petit JM,Nougaret S,et al.Intravoxel incoherent motion diffusion-weighted imaging in the liver:comparison of mono-,bi-and tri-exponential modelling at 3.0-T[J].European Radiol,2015,25(6):1541-1550.
[10]周萍,侯文强,吕元军,等.肝脏CT灌注成像对肝动脉栓塞化疗联合中药治疗原发性肝癌的临床疗效评价[J].解放军医药杂志,2016,28(1):52-54.
[11]王勇,靳光华,江广斌.原发性肝癌的功能16层螺旋CT成像评估分析[J].现代肿瘤医学,2015,23(21):3139-3142.
[12]郑兴菊,郑捷,孙家瑜,等.磁共振T1ρ成像在原发性肝癌诊断中应用的初步探索[J].中国普外基础与临床杂志,2015,22(6):743-745.
[13]赵凯.1.5T超导型全身MRI弥散加权成像用于诊断肝脏良恶性病变临床价值分析[J].中国CT和MRI杂志,2015,13(4):66-69.
[14]陈娟,尹化斌.磁共振扩散加权成像在肝脏疾病中的应用[J].临床肝胆病杂志,2015,31(1):139-142.
[15]Achiam MP,Logager VB,Skjoldbye B,et al.Preoperative CT versus diffusion weighted magnetic resonance imaging of the liver in patients with rectal cancer;a prospective randomized trial[J].Peer J,2016,4(12):1532.
[16]宋承东,曾光,黄鼎祥,等.磁共振弥散加权成像联合LAVA技术诊断肝脏占位性病变的临床价值[J].实用肝脏病杂志,2015,18(2):201-203.
[17]Kang TW,Kim SH,Jang KM,et al.Gastrointestinal stromal tumours:Correlation of modified NIH risk stratification with diffusion-weighted MR imaging as an imaging biomarker[J].European J Radiol,2015,84(1):33-40.
[18]曹丽荣.肿瘤标志物联合甲胎蛋白检测方法在原发性肝癌患者中的诊断研究[J].中国药物与临床,2017,17(6):264-265.
[19]崔灿,牛国平.肿瘤标志物联合检测对原发性肝癌的诊断价值[J].现代肿瘤医学,2015,23(9):1262-1265.
[20]朱波,肖亚雄,彭宇生,等.GP73和AFP联合检测在原发性肝癌中的诊断价值[J].检验医学与临床,2016,13(5):595-596.