增强MDCT和普美显增强MRI对肝癌射频消融治疗后疗效评价的比较.docVIP

增强MDCT和普美显增强MRI对肝癌射频消融治疗后疗效评价的比较 　　摘要：目的 比较增强多层螺旋CT（MDCT）和普美显（Gd-EOB-DTPA）增强MRI对肝癌射频消融（RFA）治疗后疗效评价的价值。方法 选取于我院行RFA治疗的34例原发性肝癌患者，共42个病灶。所有患者均行增强MDCT和普美显增强MRI复查，图像由2位放射科医生进行分析，评价肿瘤有无残存或复发。结果 RFA术后1个月，42个病灶中32个病灶完全消融，10个病灶有肿瘤残存，并有6个新发病灶。增强MDCT发现34个完全消融病灶，8个肿瘤残存病灶，2个新发病灶。普美显增强MRI发现31个完全消融病灶，11个肿瘤残存病灶，6个新发病灶。普美显增强MRI图像显示RFA术后肿瘤残存的敏感性和准确性均高于增强MDCT，差异有统计学意义（均P0.05），而两者的特异性之间比较并无统计学意义（P=0.606）。普美显增强MRI对RFA术后新发病灶的发现率高于增强MDCT，但差异亦无统计学意义（P=0.066）。结论 普美显增强MRI在肝癌RFA治疗后肿瘤残存或者复发的准确性和检出方面均优于增强MDCT。 　　关键词：肝癌；射频消融；MDCT；MRI；普美显 　　Abstract：Objective To compare enhanced multi-detector computerized tomography（MDCT）with MRI with Gd-EOB-DTPA in assessing tumor regression after radiofrequency ablation（RFA）after hepatocellular carcinomas（HCC）.Methods 34 patients（42 HCCs）from Jau.2012 to Dec.2014 were treated with RFA and underwent enhanced MDCT and MRI with Gd-EOB-DTPA for follow up.Two radiologists reviewed these images and detection of residual or recurrent tumor were assessed.Results 32 nodules were necrotic lesions after treatment，10 showed residual diseases，and 6 new HCCs were identified.At 1 month after RFA enhanced CT has identified 34 necrotic lesions，8 residual diseases and 2 new HCCs.At MRI with Gd-EOB-DTPA instead，31 complete necrotic lesions，11 residual diseases and 6 new HCCS were identified.The sensitivity and accuracy of MRI with Gd-EOB-DTPA in detecting residual diseases were significantly higher than those of enhanced MDCT（All P0.05）but the difference in the specificity between them was not statistical（P=0.606）.The rate of detecting new HCCs of MRI with Gd-EOB-DTPA were higher than that of enhanced MDCT，but the difference was not statistical（P=0.066）.Conclusion MRI with Gd-EOB-DTPA is superior to enhanced MDCT in diagnostic accuracy and detection rate of residual diseases or recurrent tumor after RFA. 　　Key words：Hepatocellular carcinoma；Radiofrequency ablation；MDCT；MRI；Gd-EOB-DTPA 　　手术治疗一直是原发性肝癌的首选治疗方式，但对于直径小于5 cm的肝癌，射频消融（RFA）可以达到与手术治疗同样的效果，且具有创伤小、术后恢复快等优势[1]。对于RFA