肝内胆管细胞癌增强CT扫描特征及其诊断价值分析*

doi:10.3969/j.issn.1672-5069.2024.03.032

摘要/Abstract

摘要： 目的分析肝内胆管细胞癌(ICC)的CT增强扫描特征,探讨其诊断价值。方法 2020年3月～2023年3月我院诊治的376例经超声检查发现的肝脏占位性病变患者,均行CT平扫和多期增强扫描检查,所有患者接受穿刺活检或手术组织病理学检查诊断。采用kappa系数检验CT扫描的诊断价值。结果在376例肝占位性病变患者中,经病理学检查诊断为良性病变149例和恶性病变227例,后者包括ICC者18例和肝细胞癌(HCC)者209例;CT增强扫描检出良性病变151例,恶性病变225例;CT扫描诊断ICC 患者21例,均为单发病灶,肝左叶病灶占61.9%,病灶直径为(6.7±1.8)cm,肿块型病灶占57.1%。肿块型动脉期主要为病灶边缘薄层轻度强化,静脉期均显示病灶边缘薄层轻度强化,延迟期均显示病灶强化加强;腔内生长型动脉期主要为肝门附近局部软组织病灶轻度强化,静脉期均显示病灶进一步强化,延迟期均显示病灶缓慢持续强化;浸润型动脉期主要为肝内胆管壁轻度强化,静脉期均显示病灶进一步强化,延迟期均显示病灶缓慢持续强化;在CT增强扫描检出的225例恶性病变患者中,经病理学检查诊断为非ICC 者208例,ICC者 17例;多期CT增强扫描检出非ICC者204例,ICC 者21例,其诊断ICC与病理组织学检查一致性检验的Kappa值为0.766,其准确率、敏感度、特异度、阳性预测值和阴性预测值分别为94.1%、97.6%、97.3%、76.2%和99.5%。结论多期CT增强扫描诊断ICC的准确度较高,其扫描特征对指导临床手术方案的选择具有重要的意义。

关键词: 肝内胆管细胞癌, CT平扫和增强, 特征, 诊断

Abstract: Objective The aim of this study was to analyze the CT enhancement scan imaging feature of cholangiocellular carcinoma (CCC) in a series of patients with intrahepatic space-occupying lesions (ihSOL). Methods A total of consecutive 376 patients with ihSOL revealed by ultrasonography were encountered in our hospital between March 2020 and March 2023, and all underwent CT plain scan and multi-phase enhancement scan. The diagnosis was made based on pathology from tissues obtained by laparoscopic radical operation or fine needle aspiration biopsy. The diagnostic performance of multi-phase CT enhancement scan was analyzed by Kappa coefficient test. Results Out of the 376 patients with ihSOL, the pathological examination showed that there were 149 cases with benign lesions and 227 cases with malignant lesions, including CCC in 18 cases and hepatocellular carcinoma (HCC) in 209 cases; the multi-phase CT enhancement scan diagnosed benign lesions in 151 cases and malignant lesions in 225 cases, including ICC in 21 cases, all single lesion, 61.9% of them located in left lobe, 57.1% of them shaped in mass, with the diameters of(6.7±1.8)cm; the edges of mass tumors mildly intensified at arterial phase and portal phase, while vigorously intensified at delayed phase; the intra-lumen tumors adjacent to porta hepatis mildly intensified at arterial phase, gradually further intensified at portal and delayed phases; intrahepatic infiltrating tumors at bile duct walls mildly intensified, gradually persistently intensified at portal and delayed phases; out of the 225 patients with malignant lesions [intrahepatic cholangiocellular carcinoma (ICC) in 21 and HCC in 204 cases] demonstrated by CT scan, the pathological examination diagnosed ICC in 17 cases and HCC in 208 cases (Kappa=0.766), with the diagnostic accuracy, sensitivity, specificity, positive predictive value and negative predictive value of 94.1%, 97.6%, 97.3%, 76.2% and 99.5%. Conclusion The feature of ICC by multi-phase CT enhancement scan is characteristic, which might help the clinicians make a plan for management.

Key words: Cholangiocellular carcinoma, CT plain and enhancement scan, Feature, Diagnosis

师玉, 孟令辉, 王禄马. 肝内胆管细胞癌增强CT扫描特征及其诊断价值分析^*[J]. 实用肝脏病杂志, 2024, 27(3): 446-449.

Shi Yu, Meng Linghui, Wang Luma. CT enhancement scan imaging feature of cholangiocellular carcinoma: An analysis of 18 cases[J]. Journal of Practical Hepatology, 2024, 27(3): 446-449.

参考文献

[1] Banales JM, Marin JJG, Lamarca A, et al. Cholangiocarcinoma 2020: the next horizon in mechanisms and management. Nat Rev Gastroenterol Hepatol,2020,17(9):557-588.
[2] Beaufrère A, Calderaro J, Paradis V. Combined hepatocellular-cholangiocarcinoma: An update. J Hepatol,2021,74(5):1212-1224.
[3] Kendall T, Verheij J, Gaudio E, et al. Anatomical, histomorphological and molecular classification of cholangiocarcinoma. Liver Int,2019,39(1):7-18.
[4] Elvevi A, Laffusa A, Scaravaglio M, et al. Clinical treatment of cholangiocarcinoma: an updated comprehensive review. Ann Hepatol,2022,27(5):100737.
[5] Mosconi C, Calandri M, Javle M, et al. Interventional radiology approaches for intra-hepatic cholangiocarcinoma. Chin Clin Oncol,2020,9(1):8-12.
[6] Nakamura Y, Higaki T, Honda Y, et al. Advanced CT techniques for assessing hepatocellular carcinoma. Radiol Med,2020,126(7):925-935.
[7] Goo HW. Four-Dimensional thoracicCT in free-breathing children. Korean J Radiol,2019,20(1):50-57.
[8] Agostini A, Borgheresi A, Bruno F, et al. New advances in CT imaging of pancreas diseases: a narrative review. Gland Surg,2020,9(6):2283-2294.
[9] Buus TW, Rasmussen F, Nellemann HM, et al. Comparison of contrast-enhanced CT, dual-layer detector spectral CT, and whole-body MRI in suspected metastatic breast cancer: a prospective diagnostic accuracy study. Eur Radiol,202,31(12):8838-8849.
[10] Husmann L, Huellner MW, Gruenig H, et al. Imaging characteristics and diagnostic accuracy of FDG-PET/CT, contrast enhanced CT and combined imaging in patients with suspected mycotic or inflammatory abdominal aortic aneurysms. PLoS One,2022,17(8):272772-272779.
[11] Mejia JC, Pasko J. Primaryliver cancers: Intrahepatic cholangiocarcinoma and hepatocellular carcinoma. Surg Clin North Am,2020,100(3):535-549.
[12] Macias RIR, Monte MJ, Serrano MA, et al. Impact of aging on primary liver cancer: epidemiology, pathogenesis and therapeutics. Aging (Albany NY),2021,13(19):23416-23434.
[13] Khan SA, Tavolari S, Brandi G. Cholangiocarcinoma: Epidemiology and risk factors. Liver Int,201,39(1):19-31.
[14] Dondossola D, Ghidini M, Grossi F, et al. Practical review for diagnosis and clinical management of perihilar cholangiocarcinoma. World J Gastroenterol,2020,26(25):3542-3561.
[15] Lee YT, Wang JJ, Luu M, et al. Comparison of clinical features and outcomes between intrahepatic cholangiocarcinoma and hepatocellular carcinoma in the united states. Hepatology,2021,74(5):2622-2632.
[16] Mar WA, Chan HK, Trivedi SB, et al. Imaging ofintrahepatic cholangiocarcinoma. Semin Ultrasound CT MR, 2020,42(4):366-380.
[17] Mahmoudi S, Bernatz S, Althoff FC, et al. Dual-energy CT based material decomposition to differentiate intrahepatic cholangiocarcinoma from hepatocellular carcinoma. Eur J Radiol,2022,156(1):110556-110562.
[18] Wakiya T, Ishido K, Kimura N, et al. CT-based deep learning enables early postoperative recurrence prediction for intrahepatic cholangiocarcinoma. Sci Rep,2022,12(1):8428-8435.
[19] Fiz F, Masci C, Costa G, et al. PET/CT-based radiomics of mass-forming intrahepatic cholangiocarcinoma improves prediction of pathology data and survival. Eur J Nucl Med Mol Imaging,2022,49(10):3387-3400.
[20] Clements O, Eliahoo J, Kim JU, et al. Risk factors for intrahepatic and extrahepatic cholangiocarcinoma: A systematic review and meta-analysis. J Hepatol,2020,72(1):95-103.
[21] Xue B, Wu S, Zhang M, et al. A radiomic-based model of different contrast-enhanced CT phase for differentiate intrahepatic cholangiocarcinoma from inflammatory mass with hepatolithiasis. Abdom Radiol (NY),2021,46(8):3835-3844.
[22] Zhao F, Pang G, Li X, et al. Value of perfusion parameters histogram analysis of triphasic CT in differentiating intrahepatic mass forming cholangiocarcinoma from hepatocellular carcinoma. Sci Rep,2021,11(1):23163-23169.

肝内胆管细胞癌增强CT扫描特征及其诊断价值分析^*

CT enhancement scan imaging feature of cholangiocellular carcinoma: An analysis of 18 cases

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