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目的 对比分析CT和MRI评价原发性肝癌TACE治疗后肿瘤残存和病灶稳定性的能力。方法 2 8例原发性肝癌患者 ,分别于 1～ 4次肝TACE治疗后 2～ 6月行CT、MRI和动脉造影 ,3项检查均于 1月内完成。以动脉造影和临床随访 6个月以上的结果为标准 ,分析和比较CT和MRI对肿瘤残存的显示情况。结果 2 8例患者共有病灶 46个。动脉造影和临床随访证实无肿瘤残存病灶 15个 ,有肿瘤残存病灶 3 1个。CT判断有肿瘤残存病灶 2 0个 ,无肿瘤残存或无法判断的病灶 2 6个 ,其敏感性为64.5% ,特异性为 10 0 % ,准确性为 76.1%。MRI判断有肿瘤残存病灶 2 9个 ,无肿瘤残存病灶 17个 ,其敏感性为 93 .5% ,特异性为10 0 % ,准确性为 95.7%。CT和MRI判断肿瘤残存的敏感性和准确性均有明显差异 (Ρ <0 .0 1)。结论 CT可清晰显示肝TACE治疗后碘油在病灶内分布情况。MRI能更清楚地显示肝TACE治疗后肿瘤坏死和残存 ,从而更准确地评价肝TACE疗效。并且MRI更能鉴别无碘油沉积区是肿瘤残存或肿瘤自然坏死、出血或纤维化等情况。
Objective To compare the ability of CT and MRI to evaluate the residual tumor and the stability of the lesion after TACE treatment of primary liver cancer. Methods Twenty-eight patients with primary liver cancer underwent CT, MRI and arteriography 2 to 6 months after liver TACE treatment 1 to 4, respectively. All 3 tests were completed within 1 month. The results of arterial angiography and clinical follow-up of 6 months or more were used as the standard to analyze and compare the CT and MRI findings of tumor residual. Results There were 46 lesions in 28 patients. Arteriography and clinical follow-up confirmed that no tumor residual lesions 15, there are 31 tumor residual lesions. There were 20 tumor-remaining lesions on CT scan, and 26 lesions were non-tumor-related or indeterminable with a sensitivity of 64.5%, specificity of 100% and accuracy of 76.1%. There are 29 tumor residual lesions and 17 tumor residual lesions without MRI, the sensitivity is 93.5%, the specificity is 100% and the accuracy is 95.7%. The sensitivity and accuracy of CT and MRI in determining the residual tumor were significantly different (P <0.01). Conclusion CT can clearly show the distribution of iodized oil in lesion after TACE treatment. MRI can more clearly show the tumor necrosis and residual after TACE, so as to evaluate liver TACE more accurately. And MRI is more able to identify non-iodized oil deposition area is the tumor residual tumor or natural necrosis, bleeding or fibrosis and so on.