非刚性三维校正肝脏MR动态减影技术应用于肝细胞癌经导管动脉内化疗栓塞术后疗效评估的研究

doi:10.3877/cma.j.issn.1674-0793.2015.05.014

中华普通外科学文献(电子版) ›› 2015, Vol. 09 ›› Issue (05) : 382 -388. doi: 10.3877/cma.j.issn.1674-0793.2015.05.014

所属专题：专题评论；文献；

论著

非刚性三维校正肝脏MR动态减影技术应用于肝细胞癌经导管动脉内化疗栓塞术后疗效评估的研究

王猛¹, 蔡华崧¹, 高进云², 朱莹¹, 张永裕³, 黄梦琪¹, 辛丽丽⁴, 冯仕庭¹^,^†(

)

^1. 510080　广州，中山大学附属第一医院放射诊断专科
^2. 518033　深圳市中医院放射影像科
^3. 510080　广州，中山大学附属第一医院放射介入专科
^4. 262100　山东省安丘市妇幼保健院超声科

收稿日期:2015-07-05 出版日期:2015-10-01
通信作者: 冯仕庭

Application of non rigid 3D-registration for accurate subtraction of dynamic liver MR imaging technique in tumor blood supply assessment for hepatocellular carcinoma after transarterial chemoembolization

Meng Wang¹, Huasong Cai¹, Jinyun Gao², Ying Zhu¹, Yongyu Zhang³, Mengqi Huang¹, Lili Xin⁴, Shiting Feng¹^,^†()

^1. Department of Diagnostic Radiology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
^2. Department of Radiology, Shenzhen Traditional Chinese Medicine Hospital, Shenzhen 518033, China
^3. Department of Interventional Radiology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
^4. Department of Ultrasonography, Anqiu Maternal and Child Hygiene Hospital, Anqiu 262100, China

Received:2015-07-05 Published:2015-10-01
Corresponding author: Shiting Feng
About author:
Corresponding author: Feng Shiting, Email: fst1977@163.com

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引用本文：

王猛, 蔡华崧, 高进云, 朱莹, 张永裕, 黄梦琪, 辛丽丽, 冯仕庭. 非刚性三维校正肝脏MR动态减影技术应用于肝细胞癌经导管动脉内化疗栓塞术后疗效评估的研究[J]. 中华普通外科学文献(电子版), 2015, 09(05): 382-388.

Meng Wang, Huasong Cai, Jinyun Gao, Ying Zhu, Yongyu Zhang, Mengqi Huang, Lili Xin, Shiting Feng. Application of non rigid 3D-registration for accurate subtraction of dynamic liver MR imaging technique in tumor blood supply assessment for hepatocellular carcinoma after transarterial chemoembolization[J]. Chinese Archives of General Surgery(Electronic Edition), 2015, 09(05): 382-388.

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。

关键词: CT, MRI, 减影, DSA, TACE

Objective

To compare the capacity between contrast-enhanced computed tomography (CT) and non rigid 3D-registration for accurate subtraction of dynamic liver magnetic resonance imaging (MRI) in tumor blood supply assessment for hepatocellular carcinoma(HCC) after transarterial chemoembolization(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 therapy were included in the study. All the patients underwent both contrast-enhanced CT and MRI. MRI examination 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 images and the MRI image that dealt with non rigid 3D-registration were collected. Digital subtraction angiography (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 accuracy 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 sensitivity, specificity, false positive rate, false negative rate, correct indices, positive likelihood ratio, negative 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 assessment for HCC after TACE than CT and has important clinical value.

Key words: CT, MRI, Subtraction, DSA, TACE

图1 致密结节状沉积：肝实质内见多发碘油沉积灶，碘油在结节内均匀分布，基本填充结节

图2 斑片状沉积：肝右叶见巨大碘油沉积灶，碘油在肿块内分布不均匀

表1 CT、MR及DSA发现病灶的阳性率[n(%)]

项目		n	CT	MR	DSA
全部病灶		126	10(7.94)	116(92.06)	107(89.68)
碘油分布类型		?	?	?	?
?	致密结节状沉积	113	1(0.88)	105(92.92)	104(91.15)
?	斑片状沉积	13	9(69.23)	11(84.62)	7(76.92)
结节类型		?	?	?	?
?	大结节(≥2 cm)	18	7(38.89)	16(88.89)	13(83.33)
?	小结节(<2 cm)	108	3(2.78)	100(92.59)	102(90.74)
病灶位置		?	?	?	?
?	肝左叶	36	1(2.78)	31(86.11)	38(83.33)
?	肝右叶	90	9(0.10)	85(94.44)	85(92.22)

表1 CT、MR及DSA发现病灶的阳性率[n(%)]

项目		n	CT	MR	DSA
全部病灶		126	10(7.94)	116(92.06)	107(89.68)
碘油分布类型		?	?	?	?
?	致密结节状沉积	113	1(0.88)	105(92.92)	104(91.15)
?	斑片状沉积	13	9(69.23)	11(84.62)	7(76.92)
结节类型		?	?	?	?
?	大结节(≥2 cm)	18	7(38.89)	16(88.89)	13(83.33)
?	小结节(<2 cm)	108	3(2.78)	100(92.59)	102(90.74)
病灶位置		?	?	?	?
?	肝左叶	36	1(2.78)	31(86.11)	38(83.33)
?	肝右叶	90	9(0.10)	85(94.44)	85(92.22)

图3 肝实质内多发碘油致密沉积结节, CT增强扫描动脉期(A)肝实质内未见明确异常强化灶,CT增强扫描门静脉(B)难以明确是否有HCC复发。MR增强扫描动脉期减影(C)可见肝实质内见多发强化结节, DSA(D)亦证实为HCC复发

图4 肝右叶见一巨大斑片状碘油沉积肿块, CT增强扫描动脉期(A)及门静脉(B)未能明确结节是否有血供。MR增强扫描动脉期减影(C)可见肿块边缘仍有丰富的血供, DSA(D)亦证实有血供

表2 CT、MR对结节的血供判断的比较

分类	组别	χ²值	P值	灵敏度（%）	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（%）
全部病灶	CT/DSA	94.450	<0.001	6.2	76.0	23.1	93.8	0.02	0.27	1.22	13.5
全部病灶	MR/DSA	?	0.375	99.1	69.2	30.8	0.9	0.68	3.22	0.01	96.0
致密结节	CT/DSA	100.010	<0.001	1.0	100.0	0	99.0	0.01	0.01	0.99	9.7
致密结节	MR/DSA	?	0.625	99.0	70.0	30.0	1.0	0.69	3.30	0.01	96.5
斑片状沉积	CT/DSA	N	1.000	60.0	0	100.0	40.0	0.04	0.60	0.86	46.2
斑片状沉积	MR/DSA	?	1.000	100.0	66.7	33.3	0	0.67	3.00	0.00	92.3
大结节	CT/DSA	N	0.021	40.0	66.7	33.3	60.0	0.03	1.20	0.90	44.4
大结节	MR/DSA	?	1.000	100.0	66.7	33.3	0	0.67	3.00	0.00	94.4
小结节	CT/DSA	89.253	<0.001	1.0	80.0	20.0	99.0	0.01	0.05	1.24	8.3
小结节	MR/DSA	?	0.625	99.0	70.0	30.0	1.0	0.69	3.30	0.01	96.3
肝左叶	CT/DSA	25.290	<0.001	0	83.3	16.7	100.0	0.02	0.01	1.20	13.9
肝左叶	MR/DSA	?	1.000	100.0	83.3	16.7	0	0.83	6.00	0.00	97.2
肝右叶	CT/DSA	68.321	<0.001	8.4	71.4	28.6	91.6	0.02	0.30	1.28	13.3
肝右叶	MR/DSA	?	0.625	98.8	57.1	42.9	1.2	0.56	2.31	0.02	95.6

表2 CT、MR对结节的血供判断的比较

分类	组别	χ²值	P值	灵敏度（%）	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（%）
全部病灶	CT/DSA	94.450	<0.001	6.2	76.0	23.1	93.8	0.02	0.27	1.22	13.5
全部病灶	MR/DSA	?	0.375	99.1	69.2	30.8	0.9	0.68	3.22	0.01	96.0
致密结节	CT/DSA	100.010	<0.001	1.0	100.0	0	99.0	0.01	0.01	0.99	9.7
致密结节	MR/DSA	?	0.625	99.0	70.0	30.0	1.0	0.69	3.30	0.01	96.5
斑片状沉积	CT/DSA	N	1.000	60.0	0	100.0	40.0	0.04	0.60	0.86	46.2
斑片状沉积	MR/DSA	?	1.000	100.0	66.7	33.3	0	0.67	3.00	0.00	92.3
大结节	CT/DSA	N	0.021	40.0	66.7	33.3	60.0	0.03	1.20	0.90	44.4
大结节	MR/DSA	?	1.000	100.0	66.7	33.3	0	0.67	3.00	0.00	94.4
小结节	CT/DSA	89.253	<0.001	1.0	80.0	20.0	99.0	0.01	0.05	1.24	8.3
小结节	MR/DSA	?	0.625	99.0	70.0	30.0	1.0	0.69	3.30	0.01	96.3
肝左叶	CT/DSA	25.290	<0.001	0	83.3	16.7	100.0	0.02	0.01	1.20	13.9
肝左叶	MR/DSA	?	1.000	100.0	83.3	16.7	0	0.83	6.00	0.00	97.2
肝右叶	CT/DSA	68.321	<0.001	8.4	71.4	28.6	91.6	0.02	0.30	1.28	13.3
肝右叶	MR/DSA	?	0.625	98.8	57.1	42.9	1.2	0.56	2.31	0.02	95.6

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Application of non rigid 3D-registration for accurate subtraction of dynamic liver MR imaging technique in tumor blood supply assessment for hepatocellular carcinoma after transarterial chemoembolization

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Application of non rigid 3D-registration for accurate subtraction of dynamic liver MR imaging technique in tumor blood supply assessment for hepatocellular carcinoma after transarterial chemoembolization