目的：探讨多模态磁共振成像对结节型肝细胞癌TACE+RFA术后复发灶评估的价值。材料和方法回顾性收集我院自2009年9月至2014年9月经临床或病理证实单结节型肝细胞癌并采用TACE和RFA联合治疗的患者。筛查入组105例，男87例，女18例，年龄46~83岁，中位年龄63岁。从复发点按随诊间隔逆行追溯分为三组：复发组、可疑组和术后组。结合复发组定位观察其他两组介入灶肿瘤复发区各序列信号改变及形态学征象。采用卡方检验比较三组间的各序列信号及形态改变。根据复发组各序列信号、形态的百分比进行编号。使用ROC曲线比较复发组-术后组各序列信号的诊断阈值。使用Logistics回归计算各序列同时使用信号及形态特点诊断可疑组的灵敏度、特异度。再将序列进行联合找到约登指数最大时的序列搭配。结果可疑组时信号特点：T1WI低信号、混杂信号；T2WI高信号、混杂信号；弥散加权成像(diffusion weighte dimaging, DWI)高信号，肝脏三维容积快速扫描(liver acquisition with volumeacceleration, LAVA)明显强化。形态特点：各序列大多以半月形为主。诊断效能：当 T1WI、T2WI、DWI、LAVA四个联合时诊断灵敏度、特异度分别为85.7%和94.3%。结论多模态磁共振成像技术对结节型原发性肝细胞TACE+RFA介入术后复发区的观测具有一定随访价值。%Objective: To study the follow-up value of Multi-modality imaging in the MRI assessment of recurrence after transcatheter arterial chemoembolization (TACE) combined radiofrequency ablation (RFA) of nodular hepatocellular carcinoma (HCC). Materials and Methods: The clinical and pathological characteristics of single nodular hepatocellular carcinoma confirmed by clinical or pathological between September 2009 and September 2014 were retrospectively collected, and the patients were treated by RFA and TACE. At last, 105 cases were screened, including 87 males and 18 females, aged 46—83 years, and median age of 63 years. The recurrence points were divided into three groups: recurrence group, suspicious group and postoperative group. Combined with the recurrence group, the changes of the serial signals and morphological signs of the other two groups were observed in the tumor recurrence region of the tumor recurrence region. Statistical analysis: using chi square test to compare the signal and morphological changes between the three groups. According to the sequence signal of the recurrence group, the percentage of the morphology of the group was number. Using the ROC curve to compare the diagnostic thresholds of the serial signals between the recurrent group and the postoperative group. Using logistics regression to calculate the sensitivity and specificity of each sequence using signal and morphological characteristics for the diagnosis of suspicious group. Then the sequence was joint, find the maximum Youden index sequence matching. Results: Signal characteristics of suspicious group: T1WI showed low signal and mixed signal; T2WI showed high signal and mixed signal; DWI showed hyperintensity LAVA (enhancement). Morphological characteristics: the sequence mostly with half. The diagnostic efficacy: when four joint use T1WI, T2WI, DWI, LAVA and combined diagnostic sensitivity and specificity were 85.7% and 94.3%. Conclusion: Multi-modality imaging of MRI has the potential to assess the recurrence after TACE combined RFA of nodular HCCs .
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