The Comparative Study Of MSCT And MRI In The Follow Up Of Hepatocellular Carcinoma After Treated With TACE

Objective To compare the diagnostic value and detectability of MRI dynamic enhanced with that of contrast-enhanced MSCT in evaluating the residual viable tumor and the stability of HCCs after the intervention treatment of TACE with lipiodol.Research Background Primary hepatic carcinoma (primary hepatic carcinoma, PHC) is one of the most malignant carcinomas in China. According to statistics, almost a hundred thousand people die of PHC, most of which are hepatocellular carcinoma (hepatocellular carcinoma, HCC) every year. Surgery is the main treatment for HCC, but for many patients surgery is not practical due to such factors as:hepatitis B, hepatocirrhosis, age, and hapatosis, and for some patients following surgery their health was not as good as expected. In recent years, with the rapid development of medical radiology and intervention therapy, the treatment for HCC has undergone tremendous change, and many experts, scholars, and clinicians have begun to pay more and more attention to the changes. Intervention treatment for HCC is comprised of two major methods:angio-graphy intervention and non-angiography intervention. Angiography intervention includes:selective hepatic lobe embolization, super selective hepatic segments emboli-zation, hepatic artery chemotherapy after hepatic vein temporary occlusion, trans-hepatic artery and portal vein chemotherapy and embolization, subcutaneous chemotherapy pu-mp. Non-angi- ography intervention mainly refers to the ablation therapy, which includes microwave ablation, radiofrequency ablation, hemical ablation (percutaneous ethanol injection, PEI), and argon-helium cryotherapy. Transcatheter arterial chemoembolization (TACE) is a main teatment for the inoperable hepatocellular carcinoma. As a major thera-py for these inoperable HCC case, the use of TACE can induce tumor necrosis, improve tumor resectability, reduce the likelihood of recurrence, and improve their quality of life and survival time.During and after the intervention treatment of TACE, the medical imaging equipment and techniques are neeessary, particularly, for checking the inactivation rate of the carcinomas, and for detecting residual viable tumor and recurrence. These equipment and techniques are also helpful for providing post-treatment instructions. At present, to evaluate the efficacy of TACE are based on these, such as digital subtraction angiography (DSA), medical ultrasonics (B-mode ultrasonic diagnostic, color doppler flow imaging, power dopple ultra sonography; BUD, CDFI, PDUS), computer tomography (CT), mag-netic resonance imaging (MRI), and so on. Enhanced MR imaging and multislice spiral computer tomography (MSCT) have been applied successively in clinical diagnoses of hepatic carcinoma research, and have also shown their potential in the monitoring of hepatocellular carcinoma after TACE therapy in recent years. The joint application of MSCT and MRI in the follow-up checks after HCC TACE with lipi- odol has been rare reported, however.Materials and Methods Total of forty-five patients with HCC underwent MSCT, MRI and DSA within 1.5-6.0 months after 1-5 procedure of the intervention treatment TACE. All of the three examinations were completed sequentially within four weeks. MSCT was performed with preceding plain scans and multi-phase contrast-enhanced scans subse-quent. MRI was carried out with TSE sequence and 2D-FLASH (fast low angle shot, FLASH) sequence or 3D-FLASH sequence dynamic multi-phase contrast-enhanced scans. The findings of MSCT and MRI were compared on the basis of the results of digital subtraction angiography and clinical follow-up at least six months. Results Sixty-eight lesions were found in forty-five patients. Forty-six lesions with and the other twenty-two lesions without residual viable tumor were confirmed by digital subtraction angiography and clinical follow-up. Thirty-two lesions with and thirty-six lesions without residual viable tumor were found on MSCT images, and its sensitivity, specificity, and accuracy were 69.57%,100%, and 79.40% respectively. Forty-three lesions with and twenty-five lesions without residual viable tumor were found on MRI images. MRI displayed 93.48% sensitivity,100% specificity, and 95.59% accuracy respectively. The sensitivity and accuracy between MSCT and MRI in evaluating the residual viable tumor of HCCs after TACE were significant different (p<0.01). Only three tumor envelopes were found on MSCT images, MSCT displayed 4.41% detection rate. Nineteen tumor envelopes were found on MRI images and it showed 27.94% detection rate, however. The detection rate and sensitivity between MSCT and MRI in discovering the tumor envelope of HCCs after the intervention treatment of TACE were also significant different (p<0.01).Conclusion MSCT is the commonest imaging modality in detection the residual viable tumor and the stability of HCCs, and in the follow-up of HCCs treated by the inter-vention treatment of TACE, which can demonstrate the patterns of lipiodol deposited within HCCs. MRI is superior to MSCT in demonstrating the tumor necrosis and resi-dual viable tumor of HCCs and evaluating the therapeutic effect of TACE. MRI is better than MSCT in differentiating residual tumor from tumor hemorrhage, spontaneous necrosis and fibrosis, within the areas of no lipiodol retention on MSCT images.