多层螺旋CT与MRI动态增强扫描诊断富血供肝内胆管细胞癌价值比较*

doi:10.3969/j.issn.1672-5069.2023.05.029

摘要/Abstract

摘要： 目的探讨多层螺旋计算机断层扫描(CT)与磁共振成像(MRI)动态增强扫描诊断肝内胆管细胞癌(ICC)血供的效能。方法 2019年8月～2021年6月我院收治的66例ICC患者,均行多层螺旋CT和MRI动态增强扫描检查,行肿瘤根治性切除术,行病理学检查。以病理学检查诊断富血供为依据,应用受试者工作特征曲线(ROC)下面积(AUC)评估两种检查方法的诊断效能。结果在66例ICC患者中,组织病理学检查发现富血供肿瘤26例和乏血供40例;多层螺旋CT扫描在21例富血供ICC患者动脉期检出病灶,静脉期和延迟期均为持续强化,5例在动脉期、门静脉期和延迟期均未出现明显强化;MRI动态增强扫描在24例富血供ICC患者动脉期检出病灶,呈不均匀强化,静脉期和延迟期病灶内呈不均匀片状强化,2例患者在动脉期和门静脉期病灶未出现明显强化,延迟期表现为均匀性强化;经 ROC分析显示,多层螺旋CT检查诊断富血供ICC的AUC为0.869 (95%CI:0.77～0.94),其灵敏度和特异度分别为76.9%(95%CI:59.56～90.56)和95.0%(95%CI:83.96～99.24),而MRI动态增强扫描检查诊断的AUC为0.872(95%CI:0.78～0.94),其灵敏度和特异度分别为88.5%(95%CI:70.07～95.92)和85.0%(95%CI:73.05～94.58)。结论富血供ICC在多层螺旋CT和MRI动态增强扫描上都具有一定的特征性表现,有助于术前诊断和制定合适的治疗方案,值得进一步研究。

关键词: 肝内胆管细胞癌, 多层螺旋计算机断层扫描, 磁共振成像, 影像学特征, 诊断

Abstract: Objective The aim of this study was to investigate the diagnostic performance of multi-slice computed tomography (CT) and magnetic resonance imaging (MRI) dynamic enhancement in patients with hypervascular intrahepatic cholangiocarcinoma (ICC). Methods 66 patients with ICC were admitted to our hospital between August 2019 and June 2021, and all patients underwent multi-slice spiral CT and MRI dynamic enhanced examinations, and radical resection of tumor. The CT and MRI imaging characteristics of ICC were analyzed and the histopathological examination was performed. The area under the receiver operating characteristic curve (AUC) was applied to evaluate the diagnostic efficacy. Results 26 cases with hypervascularity and 40 cases with hypovascularity of tumors were diagnosed by post-operational pathology out of our 66 patients with ICC; the multi-slice spiral CT scans showed tumor lesions in the arterial phase, with continuous enhancement in the venous phase and delayed phase in 21 patients with hypervascular ICC, while showed no obvious enhancement in the arterial phase, portal venous phase and delayed phase in 5 patients; the dynamic contrast-enhanced MRI revealed tumor lesions with heterogeneous enhancement in the arterial phase, and heterogeneous enhancement in the venous phase and delayed phase in 24 patients with hypervascular ICC, and did not appear tumorous imaging appearance in the arterial phase and in portal venous phase, and significant homogeneous enhancement in the delayed phase in 2 patients; the ROC analysis showed that the AUC was 0.869 (95%CI:0.77-0.94), with the sensitivity (Se) and specificity (Sp) of 76.9%(95%CI:59.56-90.56) and 95.0%(95%CI:83.96-99.24)by CT scan, while the AUC was 0.872(95%CI:0.78-0.94), with the Se and Sp of 88.5%(95%CI:70.07～95.92) and 85.0%(95%CI:73.05-94.58) by MR scan. Conclusions The hypervascular ICC has certain features on multi-slice spiral CT and MRI dynamic contrast-enhanced scans, which might be helpful for the evaluation of tumor with hypervascularity, and making appropriate measurement.

Key words: Intrahepatic cholangiocarcinoma, Multi-slice computed tomography, Magnetic resonance imaging, Imaging features, Diagnosis

陈园, 葛尚, 汪施妤. 多层螺旋CT与MRI动态增强扫描诊断富血供肝内胆管细胞癌价值比较^*[J]. 实用肝脏病杂志, 2023, 26(5): 718-721.

Chen Yuan, Ge Shang, Wang Shiyu. Diagnostic performance of multi-slice spiral CT and MRI dynamic enhancement in patients with hypervascular intrahepatic cholangiocarcinoma[J]. Journal of Practical Hepatology, 2023, 26(5): 718-721.

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多层螺旋CT与MRI动态增强扫描诊断富血供肝内胆管细胞癌价值比较^*

Diagnostic performance of multi-slice spiral CT and MRI dynamic enhancement in patients with hypervascular intrahepatic cholangiocarcinoma

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