CT和磁共振成像在肝细胞癌射频治疗后射频边缘评价中的作用

摘要

Objective To assess the diagnostic value of magnetic resonance imaging ( MRI) in the follow-up of patients with hepatocellular carcinomas treated with radiofrequency ablation ( RFA ) and to compare it with that of computed tomography (CT). Methods From December 2009 to September 2011, 40 patients (47 hepatocellular carcinomas) were treated with RFA after transcatheter arterial chemoembolization and underwent MRI and CT for follow-up. RFA margins were assessed on a five-point scale with receiver operating characteristic curve analysis. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were evaluated. Results The interobserver agreement rate for MRI was significantly higher (Kappa = 0. 935 ) than for CT (Kappa = 0. 714; P < 0. 05 ). The scores of 1 and 5 points for MRI, which confirms the presence or absence of residual tumor, accounted for 89.4% (84/94) , while for CT accounting for only 31.9% (30/94). The area under the receiver operating characteristic curve of MRI was significantly higher than that of CT (P < 0. 05 ) , as were the sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of detection rate ( mean, 100% , 96. 4% , 76. 9% , 100% , and 96. 8% for MRI, respectively, is. 30. 0% , 57. 1% , 10. 3% , 87. 7% , and 63. 8% for CT). Conclusion MRI is superior to CT in assessing the RFA margins in terms of the diagnostic accuracy and detection rate .%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.