DCE-MRI、DWI和MRCP联合诊断肝外胆管癌临床价值研究*

doi:10.3969/j.issn.1672-5069.2023.06.039

摘要/Abstract

摘要： 目的探讨采用磁共振动态增强成像(DCE-MRI)、磁共振弥散加权成像(DWI)与磁共振胰胆管造影成像(MRCP)联合诊断肝外胆管癌(CC)的临床价值。方法 2019年3月～2022年3月我院诊治的64例疑似肝外CC患者,经穿刺或手术病理学检查为金标准,评估DCE-MRI、DWI和MRCP联合诊断的效能。结果经组织病理学检查诊断,在64例疑似肝外CC患者中,诊断肝外CC 45例;DCE-MRI诊断检出肝外CC 46例,其中41例阳性和14例阴性与病理学检查诊断一致(Kappa=0.658,P<0.05);DWI诊断检出肝外CC 45例,其中38例阳性和12例阴性与病理学检查诊断一致(Kappa=0.476,P<0.05);MRCP诊断检出肝外CC 44例,其中40例阳性和15例阴性与病理学检查诊断一致(Kappa=0.668,P<0.05);DCE-MRI、DWI和MRCP联合诊断检出肝外CC 45例,其中43例阳性和17例阴性与病理学检查诊断一致(Kappa=0.850,P<0.05);DCE-MRI、DWI和MRCP联合诊断的灵敏度、特异度和正确性分别为95.6%%、89.5%和93.8%,显著优于任一检查的单独诊断。结论 DCE-MRI、DWI和MRCP联合诊断肝外CC的效能更高,能够为临床诊断提供重要的依据。

关键词: 肝外胆管癌, 磁共振动态增强扫描, 弥散加权成像, 磁共振胰胆管造影, 诊断

Abstract: Objective The purpose of this study was to explore the clinical efficacy of dynamic magnetic resonance contrast-enhanced imaging (DCE-MRI), diffusion-weighted magnetic resonance imaging (DWI) and magnetic resonance cholangiopancreatography (MRCP) in the diagnosis of patients with extrahepatic cholangiocarcinoma (CC). Methods 64 patients with suspected extrahepatic CC were encountered in our hospital between March 2019 and March 2022, and the histopathological diagnosis was made as the gold standard based on biopsies or post-operational examination. All patients underwent DCE-MRI, DWI scan and MRCP. The consistency of DCE-MRI, DWI, MRCP diagnosis and pathological diagnosis were compared by Kappa tests. Results The histopathological diagnosis showed that among the 64 patients with suspected extrahepatic CC, the final diagnosis of extrahepatic CC was found in 45 cases; the DCE-MRI diagnosis found extrahepatic CC in 46 cases, with 41 positive cases and 14 negative cases consistent with pathological diagnosis(Kappa=0.658, P<0.05); the DWI diagnosis detected 45 cases of extrahepatic CC, with 38 positive cases and 12 negative cases consistent with pathological diagnosis (Kappa=0.476, P<0.05); the MRCP diagnosis determined 44 cases of extrahepatic CC, with 40 positive cases and 15 negative cases consistent with pathological diagnosis (Kappa=0.668, P<0.05); the combined DCE-MRI, DWI and MRCP diagnosis found 45 cases of extrahepatic CC, with 43 positive and 17 negative cases consistent with the pathological diagnosis (Kappa=0.850, P<0.05); the sensitivity, specificity and accuracy of the combined DCE-MRI, DWI and MRCP diagnosis were 95.6%, 89.5% and 93.8%, respectively, much superior to those by anyone of the MRI detection alone. Conclusion The combination of DCE-MRI, DWI, and MRCP scan for the diagnosis of extrahepatic CC is efficacious, which could provide an reliable clue for clinical management.

Key words: Extrahepatic cholangiocarcinoma, Magnetic resonance dynamic contrast-enhanced imaging, Diffusion-weighted imaging, Magnetic resonance cholangiopancreatography, Diagnosis

张蕊, 时倩倩, 王仲秋. DCE-MRI、DWI和MRCP联合诊断肝外胆管癌临床价值研究^*[J]. 实用肝脏病杂志, 2023, 26(6): 923-926.

Zhang Rui, Shi Qianqian, Wang Zhongqiu. Clinical efficacy of DCE-MRI, DWI and MRCP in the diagnosis of patients with extrahepatic cholangiocarcinoma[J]. Journal of Practical Hepatology, 2023, 26(6): 923-926.

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DCE-MRI、DWI和MRCP联合诊断肝外胆管癌临床价值研究^*

Clinical efficacy of DCE-MRI, DWI and MRCP in the diagnosis of patients with extrahepatic cholangiocarcinoma

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