| 黄珊珊,张 维,谢昭鹏,蒋 瑶,卢 岷.超声造影联合微血管成像技术与钆塞酸二钠增强MRI评价原发性肝癌TACE术后复发的诊断效能对照分析[J].,2021,(17):3289-3294 |
| 超声造影联合微血管成像技术与钆塞酸二钠增强MRI评价原发性肝癌TACE术后复发的诊断效能对照分析 |
| Diagnostic Effect of Contrast-enhanced Ultrasound Combined with Microvascular Imaging and Gd-EOB-DTPA-enhanced MRI for Hepatocellular Carcinoma Recurred after TACE |
| 投稿时间：2020-12-23 修订日期：2021-01-17 |
| DOI：10.13241/j.cnki.pmb.2021.17.020 |
| 中文关键词: 超声造影 微血管成像 钆塞酸二钠MRI增强扫描 原发性肝癌 经导管肝动脉化疗栓塞 |
| 英文关键词: Contrast-enhanced utrasound Microvascular imaging Transcatheter arterial chemoembolization |
| 基金项目:重庆市卫生和计生委科技项目（XY201604015） |
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| 中文摘要: |
| 摘要 目的：探讨超声造影（CEUS）联合微血管成像（SMI）技术与钆塞酸二钠磁共振增强（Gd-EOB-DTPA MR增强）扫描对于原发性肝癌（HCC）经导管肝动脉化疗栓塞（TACE）术后复发的诊断效能。方法：收集2014年1月-2019年6月间我院HCC-TACE术后定期随访期间复发且存在完整CEUS、SMI、Gd-EOB-DTPA MR增强、DSA检查影像资料的患者74例，以最终DSA检查为金标准，分别比较CEUS联合SMI、Gd-EOB-DTPA MR增强及CEUS联合SMI+Gd-EOB-DTPA MR增强对于术后复发诊断的准确度、特异度、敏感度、阳性预测值、阴性预测值、约登指数，应用Kappa检验几种检查方式与DSA检查结果的一致性，并对不同诊断方式的诊断效力行组间两两比较。结果：74例HCC-TACE术后DSA证实复发者病灶共99个，CEUS+SMI+Gd-EOB-DTPG MR增强联合检查方法具有最高的诊断价值，其准确度、敏感度、特异度、阳性预测值、阴性预测值、约登指数及Kappa值分别为94.66%，95.96%，90.63%，96.94%，87.88%，0.87，0.90。组间比较CEUS联合SMI与Gd-EOB-DTPA MR增强诊断HCC-TACE术后复发具有统计学差异（P＜0.05），但Gd-EOB-DTPA MR增强对于≤2 cm的病灶诊断率明显高于CEUS联合SMI（P＜0.05），CEUS联合SMI+Gd-EOB-DTPA MR增强较CEUS联合SMI或Gd-EOB-DTPA MR增强诊断率比较均具有统计学差异（P＜0.05）。结论：CEUS联合SMI、Gd-EOB-DTPA MR增强检查均能发现HCC-TACE术后复发病灶，其中Gd-EOB-DTPA MR增强对于≤2 cm病灶诊断效果佳，但CEUS联合SMI+Gd-EOB-DTPA MR增强更有助于HCC-TACE术后复发的早期诊断，可进一步指导临床治疗。 |
| 英文摘要: |
| ABSTRACT Objective: To investigate the diagnostic efficacy of contrast-enhanced utrasound（CEUS）combined with Superb Micro vascular imaging (SMI) and Gadolinium Ethoxybenzyl Diethylene-triamine-pentaacetic-acid enhanced MRI(Gd-EOB-DTPA-MRenhanced) in evaluating hepatocellular carcinomar (HCC) recurred after transcatheter arterial chemoembolization (TACE). Methods: 74 patients who were during regular follow-up with the complete imaging of Gd-EOB-DTPA-MR enhanced, CEUS, SMI and DSA involved from January 2014 to June 2019 in our hospital, and the final DSA examination was taken as the gold standard, the accuracy rating,specificity, positive predictive value, negative predictive value and Youden index of the diagnosis of postoperative recurrence by CEUS combined with SMI, Gd-EOB-DTPA-MR enhanced and CEUS combined with SMI+ Gd-EOB-DTPA-MR enhanced were compared, Kappa value was applied to verify the consistency between several examination methods and DSA examination results, and compare the effectiveness of different diagnostic methods between groups. Results: There were 99 recurrent lesions which was confirmed by DSA after in 74 HCC-TACE postoperative patients. The diagnosis accuracy, sensitivity, specificity, positive predictive value, negative predictive value, Youden index and Kappa value of the diagnosis of CEUS combined with SMI+Gd-EOB-DTPA-MR enhanced were 94.66%, 95.96%, 90.63%, 96.94%, 87.88%, 0.87, 0.90, respectively. There was significant difference between CEUS combined with SMI and Gd-EOB-DTPA-MR enhanced in the diagnosis of HCC-TACE postoperative recurrence(P<0.05), and Gd-EOB-DTPA-MR enhanced had a significantly higher diagnosis rate of(lesions≤2 cm) compared with CEUS combined with SMI(P<0.05). SMI+Gd-EOB-DTPA-MR enhanced showed a statistically significant difference compared with CEUS combined with SMI or Gd-EOB-DTPA MR-enhancement (P<0.05). Conclusion: CEUS combined with SMI and Gd-EOB-DTPA-MR enhanced could both find recurrent HCC-TACE lesions after surgery, Among them, Gd-EOB-DTPA-MR enhanced could obtain the best diagnosis effect for lesions ≤2 cm. CEUS combined with SMI+Gd-EOB-DTPA-MR enhanced is more conducive to the early diagnosis of postoperative recurrence of HCC-TACE and can further guide clinical treatment. |
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