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MRI与CT多期动态增强扫描诊断肝硬化伴肝癌的效果比较

作者:赵 年 李春华 李德秀 张维珍

所属单位:湖北医药学院附属东风医院介入诊疗中心 (湖北 十堰 442008)

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摘要

目的 比较MRI与CT多期动态增 强扫描诊断肝硬化伴肝癌的临床价值。 方法 回顾性分析我院自2012年1月-2015 年6月收治且经病理组织学确诊为肝硬 化肝癌的34例(44个病灶)患者的临床资 料。所有患者均已接受MRI及CT多期动态 扫描,且影像学资料完整,比较MRI与 CT多期动态增强扫描在肝硬化伴肝癌患 者中的诊断效能。结果 本组34例患者共 44个病灶,CT共确诊病灶39个,诊断准 确率为88.64%;MRI确诊病灶40个,诊断 准确率为90.91%,MRI诊断准确率稍高于 CT,但两者对比差异无统计学意义(P> 0.05)。结论 MRI无明显放射损伤,可多 角度、多方位显示病变,扫描时间短, 分辨率高,其对小肝癌诊断敏感度更 高,定性准确度稍高于CT,且对肝癌血 供及包膜强化特点显示较好,可作为肝 硬化伴肝癌的首选诊断方式。

Objective To compare the clinical value of MRI and CT multi-phase dynamic contrast-enhanced scan in the diagnosis of liver cirrhosis with liver cancer. Methods The clinical data of 34 cases (44 lesions) of patients with liver cirrhosis and liver cancer confirmed by histopathology and treated in our hospital from January 2012 to June 2015 were retrospectively analyzed. All patients underwent MRI and CT multi-phase dynamic scan and the imaging data were complete. The diagnostic efficiency of MRI and CT multi-phase dynamic contrast-enhanced scan in patients with liver cirrhosis and liver cancer was compared. Results There were 44 lesions in 34 patients and 39 lesions were diagnosed by CT. The diagnostic accuracy was 88.64%, 40 lesions were diagnosed by MRI and the accuracy of MRI (90.91%) was slightly higher than that of CT but the difference was not statistically significant (P>0.05). Conclusion MRI has no obvious radiation damage and can display lesions in many angles and multi directions with short scan time and high resolution. It has higher sensity in the diagnosis of small liver cancer and the qualitative accuracy is slightly higher than that of CT. It can better display blood supply and envelope enhancement features of liver cancer. It can be taken as the preferred diagnostic method of liver cirrhosis with liver cancer.

【关键词】肝硬化肝癌;MRI;CT;诊断

【中图分类号】R445.2;R445.3

【文献标识码】A

【DOI】 10.3969/j.issn.1672- 5131.2017.05.026

前言

肝癌为临床常见恶性肿瘤,位列恶性肿瘤的第五位,近年来全球 范围内肝硬化伴肝癌发病率明显上升,且患者死亡率增加,目前已位 列肿瘤相关死亡原因前三位[1]。且我国为肝癌高发国家,其发病病例 约占全球范围的50%,在肿瘤死亡原因中仅次于肺癌[2]。以往研究表 明,肝硬化与肝癌存在密切关联。统计资料显示,肝硬化群体中肝癌 发病率在4%左右,但原发性肝癌并肝硬化患者比例占肝癌患者的70%左 右,肝癌通常可由肝硬化结节进展而来[3]。而影像学检查是明确肝硬 化患者病情进展及鉴别肝脏占位性病变的依据,其在肝癌的诊断、定 位、定性及分期中均有较大的作用,同时在评估患者预后,指导手术 方式的选择方面有其参考价值。因此早期诊断及检出肝癌是肝脏影像 学检查的关键部分,同时也是改善患者预后的重要基础[4]。基于此, 为探讨MRI与CT多期动态扫描在诊断肝硬化伴肝癌中的临床价值,我院 对收治的34例患者的临床资料展开了回顾性分析,现总结如下。