DSA和钆塞酸二钠增强MRI对肝癌术后复发微小病灶诊断的比较研究

发布时间：2018-04-23 05:04

本文选题：微小肝癌 + 数字减影血管造影　；参考：《介入放射学杂志》2017年06期

【摘要】：目的对比研究DSA和钆塞酸二钠(Gd-EOB-DTPA)增强MRI对肝癌术后复发微小病灶的诊断效能,评估其诊断价值。方法回顾性分析2011年9月至2016年3月收治的肝癌术后怀疑有微小复发病灶的患者38例,所有患者均经过DSA、DSA碘油CT和Gd-EOB-DTPA增强MRI检查,对比分析各检查方法诊断的阳性和阴性病例,计算诊断的灵敏度和特异度,所有病例均由2名放射科副主任医师根据诊断标准独立诊断,以手术或者穿刺病理结果以及至少6个月随访作为最终诊断依据。结果 38例患者,共发现47个病灶,病灶直径0.5~2.0 cm,平均(1.2±0.8)cm,其中41个病灶证实为复发微小肝癌,22个有病理结果,其余19个病灶经过随访证实。6个病灶为非肝癌病灶,全部由随访证实。所有病灶中,常规DSA诊断的灵敏度为73.2%,特异度为80.0%。DSA结合碘油CT诊断的灵敏度为90.2%,特异度为100%。Gd-EOB-DTPA增强MRI诊断的灵敏度为95.1%,特异度为100%。诊断效能之间统计学分析显示,常规DSA-DSA碘油CT以及常规DSA-MRI之间差异有统计学意义(P0.05),碘油CT与MRI间差异无统计学意义(P0.05)。结论对肝癌术后的微小肝癌结节,DSA联合碘油CT的诊断效能和GdEOB-DTPA增强MRI类似,对于临床上不适合做MRI的患者,可以考虑采用DSA联合碘油CT作为替代检查手段。
[Abstract]:Objective to evaluate the diagnostic value of DSA and Gd-EOB-DTPA enhanced MRI in the diagnosis of small recurrent lesions after liver cancer operation. Methods from September 2011 to March 2016, 38 patients with suspected minimal recurrence of liver cancer were retrospectively analyzed. All patients were examined by DSA-DSA lipiodol CT and Gd-EOB-DTPA enhanced MRI, and the positive and negative cases were compared and analyzed. The sensitivity and specificity of the diagnosis were calculated. All cases were independently diagnosed by two deputy chief radiologists according to the diagnostic criteria. The final diagnosis was based on the results of surgical or puncture pathology and follow-up for at least 6 months. Results A total of 47 lesions were found in 38 patients. The diameter of the lesions was 0.5 ~ 2.0 cm (mean 1.2 卤0.8 cm). Among them, 41 lesions were confirmed as recurrent minimal hepatocellular carcinoma, 22 had pathological findings, and the remaining 19 lesions were confirmed as non-HCC lesions after follow-up. All were confirmed by follow-up. Of all the lesions, the sensitivity of conventional DSA was 73.2, the specificity of 80.0%.DSA combined with lipiodol CT was 90.2, the specificity of 100%.Gd-EOB-DTPA enhanced MRI was 95.1 and the specificity was 100. Statistical analysis of diagnostic efficacy showed that there was significant difference between routine DSA-DSA lipiodol CT and routine DSA-MRI, but there was no significant difference between lipiodol CT and MRI. Conclusion the diagnostic efficacy of DSA combined with lipiodol CT is similar to that of GdEOB-DTPA enhanced MRI for the patients who are not suitable for MRI. We can consider using DSA combined with lipiodol CT as an alternative examination method.
【作者单位】：广西医科大学第十临床医学院(钦州市第一人民医院)介入科;
【基金】：广西钦州市科学研究与技术开发计划项目(20144004)
【分类号】：R445.2;R735.7

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