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目的回顾性分析CT和磁共振成像(MRI)在肝细胞癌(HCC)射频治疗后射频边缘评价中的作用。方法收集2009年12月至2011年9月40例(47个病灶)接受经肝动脉导管化疗栓塞后射频治疗的HCC患者多次复查的CT平扫和多期增强扫描及MRI平扫和动态增强扫描的图像,采用5分制(5分:肯定有肿瘤残存;4分:可能有肿瘤残存;3分:不确定有无肿瘤残存;2分:可能无肿瘤残存;1分:肯定无肿瘤残存)评价术后24h两种检查方法对射频边缘的显示情况,进行受试者工作特征曲线分析,计算敏感性、特异性、阳性预测值和阴性预测值。结果 MRI图像不同阅片者之间一致性非常好(Kappa=0.935),而CT图像不同阅片者之间一致性好(Kappa=0.714)。MRI评分中肯定无或有肿瘤残存的1和5分占89.4%(84/94),而CT评分中肯定无或有肿瘤残存的1和5分仅占31.9%(30/94)。MRI图像的受试者工作特征曲线下面积高于CT图像(P<0.05),MRI图像检测HCC射频治疗后射频边缘是否完整的敏感性、特异性、阳性预测值、阴性预测值和准确性,两位阅片者共同阅片后的一致结果分别是100%、96.4%、76.9%、100%和96.8%,CT图像分别是30.0%、57.1%、10.3%、87.7%和63.8%。结论 MRI在HCC射频治疗后射频边缘是否充分方面的检出及诊断的准确性都优越于CT。
Objective To retrospectively analyze the role of CT and magnetic resonance imaging (MRI) in RF edge evaluation after hepatocellular carcinoma (HCC) radiofrequency treatment. Methods A total of 40 consecutive cases (47 lesions) of HCC patients undergoing transcatheter arterial chemoembolization in December 2009 to September 2011 were enrolled in this study. CT scans and multiphase enhancement scans and MRI plain scans and dynamic enhancements were reviewed repeatedly. Scanned images were scored on a 5-point scale (5 points: there must be tumor remnants; 4 points: there may be tumor remnants; 3 points: no residual tumors; 2 points: no residual tumors; 1 point: no residual tumors ) Evaluate the appearance of radiofrequency fringe at two postoperative 24h examinations. Analyze the subject’s work characteristic curve and calculate the sensitivity, specificity, positive predictive value and negative predictive value. Results The consistency of MRI images between different readers was very good (Kappa=0.935), while the CT images had better consistency among readers (Kappa=0.714). In the MRI score, there were no tumors with or without 1 and 5 points accounting for 89.4% (84/94), while the CT scores with or without tumor residuals only accounted for 31.9% (30/94). The area under the receiver operating characteristic curve of MRI images was higher than that of CT images (P<0.05). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the radiofrequency edge after HCC radiofrequency treatment were examined by MRI images. The consensus results of the two readers’ readings were 100%, 96.4%, 76.9%, 100%, and 96.8%, respectively, and the CT images were 30.0%, 57.1%, 10.3%, 87.7%, and 63.8%, respectively. Conclusion The accuracy of the detection and diagnosis of radiofrequency radiography after radiofrequency ablation of HCC is superior to that of CT.