MRI-DWI对肝细胞癌经导管动脉化疗栓塞术后复发微小癌灶的诊断价值

Application value of MRI-DWI in recurrence of small tumors after hepatocellular carcinoma chemoembolization

摘要:

目的 探讨核磁共振-弥散加权成像（MRI-DWI）对肝细胞癌（HCC）经导管动脉化疗栓塞（TACE）术后复发微小癌灶的诊断价值。方法 选取2020年1月—2021年3月西南医科大学附属医院收治的TACE术后的195例HCC患者作为研究对象。所有患者均行数字减影血管造影（DSA）、MRI-DWI检查，以DSA诊断作为“金标准”。记录DSA、MRI-DWI检查结果，分析MRI-DWI诊断方法的效能。结果 195例TACE术后的HCC患者中89例（45.64%）经DSA诊断为术后复发微小癌灶，87例（44.61%）经MRI-DWI诊断为术后复发微小癌灶。MRI-DWI诊断显示术后复发微小癌灶患者癌灶表观扩散系数（ADC）值［（1.30±0.21）×10^-3 mm²/s］大于未发现异常者癌灶ADC值［（1.81±0.30）×10^-3 mm²/s］（P <0.05）。MRI-DWI诊断HCC患者TACE术后复发微小癌灶的敏感性为97.75%（95% CI：0.914，0.996），特异性为100.00%（95% CI：0.956，0.100）。MRI-DWI、DSA诊断HCC患者TACE术后复发微小癌灶的一致性κ值为0.798。结论 MRI-DWI与DSA诊断HCC患者TACE术后复发微小癌灶效能类似，MRI-DWI具有临床推广价值。

Abstract:

Objective To explore the application value of MRI-DWI in the recurrence of small tumors after hepatocellular carcinoma (HCC) transcatheter arterial chemoembolization (TACE).Methods A total of 195 patients with HCC after TACE who were admitted to our hospital were selected as the research objects from January 2020 to March 2021. All patients were given digital subtraction angiography (DSA) and MRI-DWI. The DSA diagnosis result is regarded as the "gold standard." The results of DSA and MRI-DWI were recorded. The efficacy of MRI-DWI diagnostic method was analyzed.Results Among the 195 patients with HCC after TACE, 89 (45.64%) patients were diagnosed as recurring microcarcinomas by DSA, and 87 (44.61%) patients were diagnosed as recurring microcarcinomas by MRI-DWI. MRI-DWI diagnosis showed that the apparent diffusion coefficient (ADC) of recurrence microcarcinoma was higher in patients [ (1.30 ± 0.21) ×10^-3 mm²/s] than in patients without abnormalities [ (1.81 ± 0.30) ×10^-3 mm²/s] (P < 0.05). The sensitivity and specificity of MRI-DWI for the diagnosis of recurrent microcarcinoma after TACE in HCC patients were 97.75% (95% CI: 0.914, 0.996) and 100.00% (95% CI: 0.956, 0.100). The consistent kappa value of DSA and MRI-DWI in diagnosing recurrence of small cancers after TACE in HCC patients was 0.798.Conclusion DSA and MRI-DWI have similar efficacy in diagnosing recurrence of small cancers after TACE in HCC patients, and MRI-DWI has clinical promotion value.