增强CT和增强MRI诊断肝细胞癌经肝动脉化疗栓塞术后病灶存活或复发价值的Meta分析

李栋; 罗天杨; 冉亚伟

doi:10.3969/j.issn.1001-5256.2019.10.017

增强CT和增强MRI诊断肝细胞癌经肝动脉化疗栓塞术后病灶存活或复发价值的Meta分析

DOI: 10.3969/j.issn.1001-5256.2019.10.017

1. 白银市第一人民医院影像中心
2. 甘肃中医药大学附属第三医院

详细信息

中图分类号: R735.7;R730.44;R445.2
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出版历程
- 收稿日期: 2019-05-27
- 出版日期: 2019-10-20

Value of contrast-enhanced computed tomography and magnetic resonance imaging in diagnosis of residual or recurrent lesion after transcatheter arterial chemoembolization in hepatocellular carcinoma:A Meta-analysis

Imaging Center,The First people's Hospital of Baiyin

摘要

摘要: 目的系统评价增强CT（CECT）和增强磁共振成像（CEMRI）诊断肝细胞癌（HCC）经肝动脉化疗栓塞术（TACE）术后存活或复发病灶的临床价值。方法检索Pub Med、Embase、Cochrane Library、Web of Science、CNKI、万方数据库中CECT和（或） CEMRI诊断TACE术后存活或复发HCC病灶的研究,检索时间截止至2019年4月。由2位研究人员独立筛选文献、提取资料后,根据QUADAS-2标准评价纳入研究的偏倚风险后,采用Stata 12. 0和Revman 5. 3软件汇总分析敏感度、特异度、受试者工作特征曲线下面积（AUC）。结果共纳入13篇CECT及13篇CEMRI诊断TACE术后存活或复发HCC病灶的研究,分别包括748例患者的934个病灶和557例患者的847个病灶。CECT诊断TACE术后存活或复发HCC病灶的13项研究中存在高度异质性（P=0. 001,Q=12. 56,I2=84. 08%）; CEMRI诊断TACE术后存活或复发HCC病灶的13项研究中不存在明显异质性（P=0. 473,Q=0. 11,I2=0）。CECT诊断TA...
- 癌,肝细胞 /
- 体层摄影术,X线计算机 /
- 磁共振成像 /
- Meta分析(主题)
Abstract: Objective To systematically evaluate the value of contrast-enhanced computed tomography(CECT) and contrast-enhanced magnetic resonance imaging(CEMRI) in the diagnosis of residual or recurrent lesion after transcatheter arterial chemoembolization(TACE)in hepatocellular carcinoma(HCC). Methods Pub Med,Embase,Cochrane Library,Web of Science,CNKI,and Wanfang Data were searched for studies on CECT and/or CEMRI in the diagnosis of residual or recurrent lesion after TACE published up to April 2019. After two reviewers independently performed literature screening,data extraction,and assessment of the risk of bias using the QUADAS-2 tool,Stata 12. 0 and Rev Man 5. 3 were used to analyze pooled sensitivity,specificity,and area under the receiver operator characteristic curve(AUC). Results A total of 13 studies on CECT and 13 studies on CEMRI in the diagnosis of residual or recurrent HCC lesion after TACE were included,with 934 lesions from 748 patients and 847 lesions from 557 patients,respectively. High heterogeneity was observed in the 13 studies on CECT in the diagnosis of residual or recurrent HCC lesion after TACE(P = 0. 001,Q = 12. 56,I2= 84. 08%),while no significant heterogeneity was observed in the 13 studies on CEMRI(P = 0. 473,Q = 0. 11,I2= 0). In the diagnosis of residual or recurrent HCC lesion after TACE,CECT had a sensitivity of 72%(95% confidence interval [CI]: 66%-78%),a specificity of 99%(95% CI: 93%-100%),and an AUC of 0. 87(95% CI: 0. 83-0. 89),and CEMRI had a sensitivity of 88%(95% CI: 82%-93%),a specificity of 96%(95% CI: 91%-98%),and an AUC of 0. 98(95% CI: 0. 96-0. 99). CECT had a significantly lower sensitivity than CEMRI in the diagnosis of residual or recurrent HCC lesion after TACE(Z = 2. 12,P = 0. 03). Conclusion In comparison with CECT,CEMRI has an extremely higher diagnostic efficiency in the diagnosis of residual or recurrent HCC lesion after TACE and is thus an effective method for diagnosis.
- carcinoma,hepatocellular /
- tomography,X-Ray computed /
- magnetic resonance imaging /
- Meta-analysis as topic

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参考文献(34)

[1] Chinese College of Interventionalists. Chinese Clinical Practice Guidelines for transarterial chemoembolization of hepatocellular carcinoma[J]. J Intervent Radiol,2018,27(12):1117-1126.(in Chinese)中国医师协会介入医师分会．中国肝细胞癌经动脉化疗栓塞治疗(TACE)临床实践指南[J]．介入放射学杂志，2018,27(12):1117-1126.

[2] PAGE AJ,COSGROVE DC,PHILOSCOPHE,et al. Hepatocellular carcinoma:Diagnosis,management,and prognosis[J]. Surg Oncol Clin N Am,2014,23(2):289-311.

[3] WHITING PF,RUTIES AW,WESTWOOD ME,et al. QUADAS-2:A revised tool for the quality assessment of diagnostic accuracy studies[J]. Ann Intern Med,2011,158(8):529-536.

[4] CHO YZ,PARK SY,CHOI EH,et al. The usefulness of contrastenhanced ultrasonography in the early detection of hepatocellular carcinoma viability after transarterial chemoembolization:Pilot study[J]. Clin Mol Hepatol,2015,21(2):165-174.

[5] CHOI SJ,KIM J,SEO J,et al. Parametric response mapping of dynamic CT for predicting intrahepatic recurrence of hepatocellular carcinoma after conventional transcatheter arterial chemoembolization[J]. Euro Radiol,2016,26(1):225-234.

[6] JANG KM,CHOI D,LIM HK,et al. Depiction of viable tumor in hepatocellular carcinoma treated with transarterial chemoembolization:Multiphasic helical CT with review of the previous serial CT images[J]. Korean J Radiol,2005,6(3):153-160.

[7] KIM HJ,KIM TK,KIM PN,et al. Assessment of the therapeutic response of hepatocellular carcinoma treated with transcatheter arterial chemoembolization:Comparison of enhanced sonography and 3-phase computed tomography[J].J Ultrasound Med,2006,25(4):477-486.

[8] LIU M,LIN MX,LU MD,et al. Comparison of enhanced ultrasound and computed tomography in evaluating the treatment response to transcatheter arterial chemoembolization of hepatocellular carcinoma using modified RECIST[J]. Euro Radiol,2015,25(8):2502-2511.

[9] PAUL SB,DHAMIJA E,GAMANAGATTI SR,et al. Evaluation of tumor response to intra-arterial chemoembolization of hepatocellular carcinoma:Comparison of contrast-enhanced ultrasound with MSCT[J]. Diagn Interv Imaging,2017,98(3):253-260.

[10] SALVAGGION G,CAMPISI A,GRECO V,et al. Evaluation of posttreatment response of hepatocellular carcinoma:Comparison of ultrasonography with second-generation ultrasound contrast agent and multidetector CT[J]. Abdom Imaging,2010,35(4):447-453.

[11] SHANG JB,LIU FY,LI YH,et al. A comparative study of 18F-FDG PET,CT and angiography in the follow up of primary liver carcinoma after transarterial chemoembolization[J]. J Chin Clin Med Imaging,2004,15(9):509-512,529.(in Chinese)商健彪，刘方颖，李彦豪，等．(18)F-FDG PET、CT和血管造影在原发性肝癌TACE后随访的对比研究[J]．中国临床医学影像杂志，2004,15(9):509-512,529.

[12] SI XW,ZHOU HL,CHEN HP,et al. Evaluation of the effect of MRI and CT in primary hepatocellular carcinoma after TACE[J].Med J West China,2017,29(8):1150-1153.(in Chinese)斯兴无，周红俐，陈华平，等．MRI与CT对原发性肝癌TACE术后的疗效评估[J]．西部医学，2017,29(8):1150-1153.

[13] TAKIZAWA K,NUMATA K,MORIMOTO M,et al. Use of contrast-enhanced ultrasonography with a contrast agent performed one day after transarterial chemoembolization for the early assessment of residual viable HCC[J]. Euro J Radiol,2013,82(9):1471-1480.

[14] WANG X,LI D,HE F,et al. Contrastive analysis of contrastenhanced ultrasound and enhanced CT in evaluating the efficacy of TACE in the treatment of primary liver cancer[J]. Hebei Med,2018,24(7):1113-1116.(in Chinese)王曦，李东，何芬，等．超声造影与增强CT评估TACE治疗原发性肝癌疗效的价值对比[J]．河北医学，2018,24(7):1113-1116.

[15] XIANG K,ZHAO HL,ZHENG CY,et al. Comparison of assessment value of 16-slice spiral CT and MRI for lesions of primary hepatic carcinoma after TACE surgery[J]. Pract J Cancer,2014,29(10):1315-1317,1321.(in Chinese)项昆，赵鹤亮，郑昌英，等．16排螺旋CT和MRI对原发性肝癌TACE术后病灶的疗效判断价值对比[J]．实用癌症杂志，2014,29(10):1315-1317,1321.

[16] YANG ML,YANG ZY,XIE CM. Comparative study on digital substraction angiography and CT diagnosis for the residual and new lesions of PHC after transcatheter arterial chemoembolization[J]. Cancer Res Clin,2014,26(3):145-147,152.(in Chinese)杨敏玲，杨志勇，谢春明．原发性肝癌经导管肝动脉化疗栓塞术后肿瘤残留及新发病灶的CT和数字减影血管造影诊断对比研究[J]．肿瘤研究与临床，2014,26(3):145-147,152.

[17] BOLOG N,PFAMMATTER T,MULLHAUPT B,et al. Doublecontrast magnetic resonance imaging of hepatocellular carcinoma after transarterial chemoembolization[J]. Abdom Imaging,2008,33(3):313-323.

[18] CEN YM,LIANG JW,TANG XY,et al. Comparison of CT and MR scan for primary hepatic carcinoma after TACE[J]. J Hepatobiliary Surg,2016,24(5):347-350.(in Chinese)岑裕铭，梁甲伟，唐小勇，等．原发性肝癌TACE术后活性灶的CT和MR对比较[J]．肝胆外科杂志，2016,24(5):347-350.

[19] FENG DP,LI NA,WANG XC,et al. Value of MRI in assessing residual tumor of hepatocellular carcinoma in patients with accumulation deposition of lipiodol after TACE[J/CD]. Chin J Inter Rad:Electronic Edition,2014,2(3):6-19.(in Chinese)冯对平，李丽娜，王效春，等．肝癌碘油栓塞后沉积良好患者的MRI随访临床研究[J/CD]．中华介入放射学电子杂志，2014,2(3):6-19.

[20] GOSHIMA S,KANEMATSU M,KONDO H,et al. Evaluating local hepatocellular carcinoma recurrence post-transcatheter arterial chemoembolization:Is diffusion-weighted MRI reliable as an indicator?[J]. J Magn Reson Imaging,2008,27(4):834-839.

[21] GUO CG,ZHANG JF,XU SL,et al. Diffusion weighted imaging combined with dynamic contrast enhanced magnetic resonance imaging in monitoring therapeutic efficacy for hepatocellular carcinoma after transcatheter arterial chemoembolization[J]. J Zhejiang Uuiversity:Medical Science,2014,43(1):77-82,88.(in Chinese)过川根，张景峰，许顺良．磁共振弥散加权成像联合动态增强在肝癌患者TACE术后病灶残留及复发监测中的应用价值[J]．浙江大学学报:医学版，2014,43(1):77-82,88.

[22] KALB B,CHAMSUDDIN A,NAZAAL L,et al. Chemoembolization follow-up of hepatocellular carcinoma with MR imaging:Usefulness of evaluating enhancement features on onemonth posttherapy MR imaging for predicting residual disease[J]. J Vasc Interv Radiol,2010,21(9):1396-1404.

[23] LIU R,WANG JH,ZHOU KR,et al. A comparative study of CT and MRI in the follow-up of hepatocellular carcinoma after transcatheter arterial chemoembolization with lipiodol[J]. J Practical Radiology,2003,19(10):902-905.(in Chinese)刘嵘，王建华，周康荣，等．原发性肝癌TACE后CT和MRI随访的对照研究[J]．实用放射学杂志，2003,19(10):902-905.

[24] PAN L,ZHENG DW. Evaluation of MSCT and MRI on the postoperatively curative effect of TACE for patient with PHC[J].China Med Equipment,2018,15(8):45-48.(in Chinese)潘利，郑大伟．多层螺旋CT与磁共振成像对原发性肝癌经肝动脉化疗栓塞术后疗效评价[J]．中国医学装备，2018,15(8):45-48.

[25] WEI J,DUAN Q,XUE YJ,et al. Dynamic contrast-enhanced VIBE sequence at 3. 0T MR:Assessment of therapeutic effect of transcatheter arterial chemoembolization for hepatocellucer carcinoma[J]. Chin J Interv Imaging,2008,5(2):115-118.(in Chinese)威晋，段青，薛蕴菁，等．3. 0T VIBE序列动态增强磁共振检查在评估经导管肝动脉化疗栓塞术治疗肝细胞癌疗效中的价值[J]．中国介入影像与治疗学，2008,5(2):115-118.

[26] YANG YW,WANG ZT,WANG Y,et al. MR diffusion weighted imaging in the prognosis evaluation of liver cancer after treatment of transcatheter arterial chemoembolization[J]. J Pract Radiol,2018,34(4):600-602,605.(in Chinese)杨耀文，王志涛，王颖．MR DWI在肝癌TACE术后评估中的应用研究[J]．实用放射学杂志，2018,34(4):600-602,605.

[27] YANG ZC. Clinical analysis of CT and MRI in evaluating tumor residual and lesion stability after primary hepatocellular carcinoma with TACE[J]. Inter Med Health Guid News,2014,20(4):512-514.(in Chinese)杨忠诚．CT和MRI评价原发性肝癌TACE治疗后肿瘤残存和病灶稳定性的临床分析[J]．国际医药卫生导报，2014,20(4):512-514.

[28] YIM JH,KIM YK,Min JH,et al. Diagnosis of recurrent HCC:Intraindividual comparison of gadoxetic acid MRI and extracellular contrast-enhanced MRI[J]. Abdom Radiol(NY),2019,44(7):2366-2376.

[29] ZHAO LF,WANG CS,ZHANG YF,et al. Preliminary study of CT perfusion and MRI of hepatocelluar carcinoma after fist transcatheter chemoem-bolization with lipiodol[J]. Chin J Misdiag,2009,9(16):3783-3785.(in Chinese)赵立峰，王昌生，张妍芬，等．原发性肝癌首次TACE术后CT灌注与MRI的研究初探[J]．中国误诊学杂志，2009,9(16):3783-3785.

[30] WALLACE MC,PREEN D,JEFFREY GP,et al. The evolving epidemiology of hepatocellular carcinoma:A global perspective[J]. Expert Rev Gastroenterol Hepatol,2015,9(6):765-779.

[31] BRAY F,FERALY J,SOERJOMATARAM,et al. Global cancer statistics 2018:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin,2018,68(6):394-424.

[32] KIM J,CHOI SJ,LEE SH,et al. Predicting survival using pretreatment CT for patients with hepatocellular carcinoma treated with transarterial chemoembolization:Comparison of models using radiomics[J]. AJR Am J Roentgenol,2018,211(5):1026-1034.

[33] LIU HF,XU YS,ZHANG Y,et al. Value of magnetic resonance morphological imaging in the diagnosis and differentiation of post-hepatitis B cirrhosis[J]. J Clin Hepatol,2018,34(12):2587-2591.(in Chinese)刘海峰，许永生，张跃，等．MR形态学成像在乙型肝炎肝硬化诊断及分期中的应用价值[J]．临床肝胆病杂志，2018,34(12):2587-2591.

[34] LEITAO HS,DOBLAS S,GARTEISER P,et al. Hepatic fibrosis,inflammation,and steatosis:Influence on the MR Viscoelastic and diffusion parameters in patients with chronic liver disease[J]. Radiology,2017,283(1):98-107.

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