A Comparative Study Of HCC After TACE In 3.0T MRI With MSCT

OBJECTIVES To research presentations on Computer Tomography(CT)and Magnetic Resonance Imaging(MRI),compare them with pathology and analysis the sensitivity and accuracy about the residual viable or recurrent tumor in patients of Hepatocellular Carcinoma(HCC)treated with transarterial chemoembolization(TACE).Materials and MethodsResearch subjects 39 patients were diagnosed as HCC in our hospital from Jan.2013 to Sep.2014,including 33 men and 6 women aged from 32 to 62 years old,with a median age of 51 years.All patients were diagnosed by combining CT,MRI etc.imaging examination with clinical data,which belonged to the clinical diagnosis.Diagnostic criteria was in conformity with the specification of Primary Liver Cancer diagnosis and treatment,2011.After 4 weeks treatment of TACE,10 patients,total of 17 HCC lesions,were performed the surgery of tumor resection and then acquired the pathological diagnosis.Inclusion criteria for this study were:1)the tumor maximum diameter had no more than 5 cm,no cancer embolus,lymph node metastasis or distant metastasis;2)in period of HCC ??? and accepted TACE treatment more than once;3)there were homogeneous,defect and cluster type in lipiodol deposition of tumor with TACE treatment.56 observation target lesions were in 39 patients.The whole liver underwent CT and MRI before and after treatment respectively.This study was approved by the Hospital Institute of Medical Ethics Committee,the patients and(or)the relatives of patients before examination with signing informed consent.Research method All patients after TACE underwent CT scan and enhanced scan,MRI scan,multiphase enhancement and diffusion weighted imaging(DWI)examination within 1?6 months,which two interval was less than one week.The preparation before checking was according to routine.Scan range:both checking were in the supine position,ranged from diaphragmatic dome to the level of lower edge of the liver.CT examination used the GE 64 layers light speed VCT and Germany Siemens dual-source CT.Scan thickness was 8 mm,enhanced scan used non-ionic contrast media ultravist(300mgl/ml).The forearm vein was taken one-off injection with high pressure injector.Dose was 2.5 ml/kg,injection speed was 3 ml/s.Scan delay time was that 22?30s called hepatic arterial phase scan,50?55s portal venous phase scan and 180s equilibrium phase scan after injection of contrast media,whose each scan time was about 6?8s.It was continual spiral scan.Scan voltage was 120kv,current was 280mA,ran at 0.5sec/circle.All coronal and sagittal of patients were reconstructed by PACS(Picture Archiving and Communications System).Reconstruction matrix was 512 X 512.MRI examination:Siemens Verio 3.0T superconducting MR scanner and body coil.Checking sequence included:1)Axial fast spin echo(TSE)T2-weighted Imaging(T2WI)fat suppression sequence:TR 4660.0ms,TE 110.0ms,signal average number 1,FOV 400cm x 400cm,matrix 320×320,scan time 59s;2)Axial gradient echo T1-weighted Imaging(T1WI)sequence:TR 170.0ms,TE 2.3ms,signal average number 1,FOV 273cm×380cm,matrix 276×512,scan time 32s;3)DWI scan b value = 50,200,500,800;4)Axial gradient echo T1WI-vibe dynamic enhancement scan,TR 3.9 ms,TE 1.4 ms,signal average number 1,FOV 273 cm×380 cm,matrix 276×512.Gd-DTPA was used as contrast agent for enhancement scan(20 ml).The ulnar vein was injected Gd-DTPA 2 ml/kg at 3 ml/s with high pressure injector(the total amount less than 20 ml),and carried out the consecutive 25 period enhanced scan.CT and MRI image analysis all patients' cases after undergoing CT and MRI scan were uploaded to the CT and MRI post-processing workstation and in image post-processing and analysis accordingly.1)Observed iodine oil deposits of tumor after TACE on CT scan images.According to the patterns of lipiodol deposited in target lesions on CT scan,it could be divided into four types:rare,homogeneous,cluster and defect type.2)Observed whether the target mass had arterial enhancement area as the basis of evaluating viable tumor on CT and MRI enhancement scan images after TALE;estimated the effect of TACE according to the diagnostic criteria of mRECIST.Arterial enhancement area on CT or MRI multiphase scan was regarded as viable tumor.The changing rate of mass size was figured out by measuring maximum diameter of arterial enhancement area on CT or MRI image before and after TACE treatment.Calculation formula was a/A×100%,if there were many enhancement areas of the lesion treated with TACE,it would be(a1+...+an)/(A1+...+An)×100%.According to the assessment criteria of mRECI'ST,this research calculated and made out evaluation of the effectiveness(complete response(CR),partial response(PR),stable disease(SD)and progression disease(PD))in HCC after TACE.3)Observed findings on MRI DWI in HCC after TACE.4)Analysed the detection rate of residual viable lesions between CT,MRI and surgical pathology in HCC treated with TACE and then removed.Statistical analysisStatistical analysis and test were performed with SPSS 19.0 software.Chi-square test was used to analyze the sensitivity and accuracy about the arterial enhancement of the residual viable lesions treated with TACE between MSCT and MRI.Independent-samples T Test was applied to compare diameter being measured of enhancement area in HCC between MSCT and MRI.Wilcoxon Rank Sum Test was used to discuss whether there was difference on accuracy about assessment of effectiveness with mRECIST between MSCT and MRI.Kappa test was used to estimate uniformity of enhancement area in HCC between DWI and MRI enhancement scan.It was suggested that when k ranged from 0.45?0.75,the consistency should be better.P value of less than 0.05 was considered statistically significant in all tests.Research report1.Compared the enhancement lesions in HCC after TACE in the arterial phase between MSCT and 3.0T MRI.2.Compared the effectiveness of HCC after TACE between MSCT and 3.0T hMRI.3.Compared the enhancement lesions in DWI with 3.0T MRI of HCC after TACE.4.Compared the residual viable lesions between MSCT,3.0T MRI and surgical pathology in HCC treated with TACE and then removed.RESULTS39 patients confirmed as HCC were found out 56 lesions on MSCT after treated with TACE.23 were homogeneous,defect 16,cluster 17 on MSCT scan.42 lesions were obviously arterial enhanced that enhancement rate was 75%and 14 lesions not arterial enhanced which belonged to the homogeneous type on CT arterial enhancement scanning.56 lesions were discovered on MRI scan and 51 lesions were arterial enhanced clearly that the rate was 91.1 percent on MRI enhancement multiphase scan,which were respectively slightly hyperintensity and(or)hypointensity on T1WI and isointensity and(or)slightly hyperintensity on T2WI.5 lesions were not arterial enhanced,which were respectively hypointensity on T1WI and isointensity and(or)hypointensity on T2WI.The arterial phase enhancement rate was 75.0%(42/56)on MSCT than that 91.1%(51/56)of MRI(P<0.05),the difference was statistically significant,so the enhancement rate was better on MRI than that of MSCT.The maximum diameter of enhancement lesions on enhancement scanning of CT and MRI were measured before TACE,which diameter was with an average of 2.96±0.45 cm on MSCT and 2.86±0.45cm on MRI.Similarly,the maximum diameter was with an average of 0.94±0.35cm on MSCT and 1.68±0.43cm on MRI after TACE.The difference of the maximum diameter had statistical significance between MSCT and MRI after TACE(P<0.05).Enhancement rate in arterial phase on MSCT and MRI was respectively 32.84± 10.17%,57.37± 10.70%in HCC after TACE,which proved the difference of enhancement rate was statistical significant between the two groups(P<0.05).According to the changing rate of enhancement area before and after TACE(a/A%),MSCT and MRI were grouped by mRECIST respectively.MSCT showed 14 CR,16 PR,21 SD,5 PD,MRI showed 5 CR,8 PR,33 SD,10 PD.There was difference on assessment of effectiveness with mRECIST between MSCT and MRI(P<0.05),that was estimate of enhancement area with mRECIST in HCC on MRI was larger than that of MSCT after TACE.With b value rising,signal of 40 enhancement lesions went up gradually,11 kept constantly,none reduced gradually in DWI multi-b(50?800s/mm2)imaging.The lesions which signals went up as b value raised agreed well with enhancement lesions(K=0.703,P<0.05).With b value rising,signal of 2 non-enhancement lesions went up gradually,9 kept constantly,25 reduced gradually.The lesions which signals reduced as b value raised agreed well with non-enhancement lesions(K=0.615,P<0.05).Conclusion1.3.0T MRI is superior to MSCT in detecting residual viable lesions enhanced in the arterial phase of HCC after TACE,especially in better lipiodol deposition lesions,furthermore,combining with DWI could improve the detecting rate about residual viable and recurrent small lesions(? 1cm)after TACE.2.3.0T MRI provides more accurate information for assessment of HCC after TACE with mRECIST.3.DWI multi-b scan for evaluation of residual viable lesion in HCC after TACE is almost similar to 3.0T MRI.