【摘要】 目的 研究常规增强CT(CECT)、多参数能谱CT及CEMR等影像学检查在肝细胞癌（HCC）TACE术后肿瘤评估的价值。方法 回顾性分析在本中心行TACE手术且术后1～3个月行常规CECT扫描、多参数能谱CT后处理和CEMR扫描的66例HCC患者。以DSA结果为金标准，将DSA下检出的复发或残存病灶归为阳性病灶，未见明显复发或残存病灶视为阴性病灶，DSA检出且其他检查方式检出的阳性病灶归为真阳性病灶。使用准确率、灵敏度、特异度、Kappa值等指标比较CECT、多参数能谱CT及CEMR在评估TACE术后阳性/阴性病灶的价值，且用检出数目及准确率评价以上检查在碘油沉积状态及其内真阳性病灶的诊断价值。结果 DSA发现阳性病灶133个，阴性病灶35个；CEMR诊断病灶的准确率最高（准确率为88.70%；均P<0.05）;CEMR和能谱CT诊断阳性病灶的效能最高（灵敏度分别为92.31%和81.95%，两者相比P>0.05），诊断阴性病灶的能力三者差异无统计学意义（均P>0.05）;Kappa值提示CEMR诊断TACE术后病灶的能力强于能谱CT(Kappa值分别为0.68和0.56；均P<0.05)。CECT跟多参数能谱CT评价碘油沉积状态准确率相同（均为91.7%）；三者诊断碘油均匀真阳性病灶无明显差异（P>0.05），诊断碘油不均匀真阳性病灶时以CEMR准确率最高（92.50%，均P<0.05）。结论 CEMR与多参数能谱CT较常规CECT诊断效能更可靠，且CEMR诊断效能最高，但评价碘油沉积状态时多参数能谱CT与CECT是更好的选择。更多还原

【Abstract】 Objective To assess the clinical value of conventional contrast enhanced CT(CECT),multi parameter energy spectrum CT,and contrast enhanced MR(CEMR)imaging methods in evaluating hepatocellular carcinoma(HCC)after TACE treatment.Methods The clinical data of 66 HCC patients,who underwent TACE treatment at authors′hospital and received CECT,multi parameter energy spectrum CT and CEMR in 1-3 months after treatment,were retrospectively analyzed.Taking DSA results as the gold standard,the recurrent or residual lesions detected by DSA were classified as positive lesions,while the lesions having no obvious recurrence or residues were classified as negative lesions.The positive lesions that were detected by both DSA and other imaging methods were regarded as true positive lesions.The accuracy,sensitivity,specificity,Kappa value were used to compare the values of CECT,multi parameter energy spectrum CT and CEMR in evaluating the positive/negative lesions of HCC after TACE treatment,and the number of detected lesions and accuracy rate were used to evaluate the values of the above imaging methods in demonstrating the iodine oil deposition status and in diagnosing true positive lesions.Results A total of 133 positive lesions and 35 negative lesions were detected by DSA.The accuracy of CEMR in diagnosing lesions was highest,the accuracy rate was 88.70%(both P<0.05);CEMR and energy spectrum CT had the highest diagnostic efficiency,the sensitivity for positive lesions was 92.31% and 81.95%respectively,and the difference between the two methods was not statistically significant(P>0.05).No statistically significant difference in the ability of diagnosing negative lesions existed between each other among the three groups(all P>0.05).The Kappa value suggested that the ability for diagnosing lesions after TACE treatment of CEMR was stronger than that of energy spectrum CT(Kappa value was 0.68 and 0.56 respectively,both P<0.05).CECT and multi parameter energy spectrum CT had the same accuracy in evaluating the iodine oil deposition status(both were 91.7%).No statistically significant difference in diagnosing even iodine oil deposition of the true positive lesions existed between each other among the three groups(all P>0.05).For diagnosing uneven iodine oil deposition of the true positive lesions,CEMR had the highest accuracy(92.50%,all P <0.05).Conclusion CEMR and multi parameter energy spectrum CT have more reliable diagnostic performance than conventional CECT,besides,CEMR has the highest diagnostic performance.However,multi parameter energy spectrum CT and CECT are the better choice for evaluating the deposition status of iodine oil.更多还原