CAJ | 학술논문

目的对比CT增强和非刚性三维校正肝脏MR增强动态减影技术对肝细胞癌(HCC)经导管动脉内化疗栓塞术(TACE)后肿瘤血供判断能力的差异,探讨非刚性三维校正肝脏MR增强动态减影技术的临床应用价值. 方法收集HCC患者TACE术后并再次需进行TACE治疗的病例21例,所有患者均行CT平扫及增强扫描﹑MR平扫及动态增强扫描,MR扫描采用非刚性三维校正动态减影技术. 分别在CT和MR增强非刚性三维校正减影图像上对病灶血供情况评估统计,以再次TACE术前的DSA评价结合结节前后的体积变化综合考虑作为金标准,比较两种检查方式对碘油沉积病灶血供评价的能力. 结果共分析126个碘油沉积灶,在对碘油沉积灶血供的判断中,CT与DSA检查诊断结果不一致(P<0.001),MR和DSA检查诊断结果一致(P=0.375); 在结节的血供判断方面,CT/MR对肝结节血供判断的敏感度﹑特异度﹑假阳性率﹑假阴性率﹑正确指数﹑阳性似然比﹑ 阴性似然比﹑ 符合率分别为6.2%/99.1%﹑76.0%/69.2%﹑23.1%/30.8%﹑93.8%/0.9%﹑0.02/0.68﹑0.27/3.22﹑1.22/0.01﹑13.5%/96.0%. 结论相对CT检查, 非刚性三维校正肝脏MR动态减影技术在HCC患者TACE治疗后疗效评估中有明显的诊断优势,具有重要的临床应用价值.
목적 대비CT증강화비강성삼유교정간장MR증강동태감영기술대간세포암(HCC)경도관동맥내화료전새술(TACE)후종류혈공판단능력적차이,탐토비강성삼유교정간장MR증강동태감영기술적림상응용개치. 방법 수집HCC환자TACE술후병재차수진행TACE치료적병례21례,소유환자균행CT평소급증강소묘﹑MR평소급동태증강소묘,MR소묘채용비강성삼유교정동태감영기술. 분별재CT화MR증강비강성삼유교정감영도상상대병조혈공정황평고통계,이재차TACE술전적DSA평개결합결절전후적체적변화종합고필작위금표준,비교량충검사방식대전유침적병조혈공평개적능력. 결과 공분석126개전유침적조,재대전유침적조혈공적판단중,CT여DSA검사진단결과불일치(P<0.001),MR화DSA검사진단결과일치(P=0.375); 재결절적혈공판단방면,CT/MR대간결절혈공판단적민감도﹑특이도﹑가양성솔﹑가음성솔﹑정학지수﹑양성사연비﹑ 음성사연비﹑ 부합솔분별위6.2%/99.1%﹑76.0%/69.2%﹑23.1%/30.8%﹑93.8%/0.9%﹑0.02/0.68﹑0.27/3.22﹑1.22/0.01﹑13.5%/96.0%. 결론 상대CT검사, 비강성삼유교정간장MR동태감영기술재HCC환자TACE치료후료효평고중유명현적진단우세,구유중요적림상응용개치.
Objective To compare the capacity between contrast-enhanced computed tomogra-phy (CT) and non rigid 3D-registration for accurate subtraction of dynamic liver magnetic resonance imag-ing (MRI) in tumor blood supply assessment for hepatocellular carcinoma(HCC) after transarterial chemoem-bolization(TACE), and to evaluate the clinical value of 3D-registration for accurate subtraction of dynamic liver magnetic resonance imaging(MRI). Methods Twenty-one patients with HCC followed TACE thera-py were included in the study. All the patients underwent both contrast-enhanced CT and MRI. MRI ex-amination used non rigid 3D-registration for accurate subtraction of dynamic liver imaging technique. And the assessment statistics of these patients' blood supply information of all the lesions both in the CT im-ages and the MRI image that dealt with non rigid 3D-registration were collected. Digital subtraction an-giography (DSA) assessment before next TACE therapy and volume changes of the nodule were considered as the golden standard to compare the ability of tumor blood supply assessment of the two methods . Results One hundred and twenty-six lipiodol accumulation lesions were analyzed. The diagnostic accu-racy was different between CT and DSA (P<0.001) while no difference between MR and DSA (P=0.375) of all the lipiodol accumulation lesion's blood supply. In the assessment of lesion's blood supply, the sen-sitivity, specificity, false positive rate, false negative rate, correct indices, positive likelihood ratio, nega-tive likelihood ratio and coincidence rate of CT/MR were 6.2%/99.1%, 76.0%/69.2%, 23.1%/30.8%, 93.8%/0.9%, 0.02/0.68, 0.27/3.22, 1.22/0.01, 13.5%/96.0%. Conclusion Non rigid 3D-registration for accurate subtraction of dynamic liver magnetic resonance imaging is superior in tumor blood supply as-sessment for HCC after TACE than CT and has important clinical value.