肝内胆管细胞癌与肝细胞癌病灶MRI增强扫描表现差异分析*

doi:10.3969/j.issn.1672-5069.2024.06.027

摘要/Abstract

摘要： 目的分析总结肝内胆管细胞癌(ICC)与肝细胞癌(HCC)病灶增强磁共振成像(MRI)表现差异,为鉴别诊断提供依据。方法 2019年12月～2023年7月我院诊治的原发性肝癌(PLC)患者120例,均接受MRI增强扫描,观察病灶强化特点,包括动脉期强化特征、动态强化模式、有无血流灌注异常、有无肝胆期靶征、病灶信号是否均匀、有无远端胆管扩张、有无包膜等特征。应用受试者工作特征曲线(ROC)下面积(AUC)分析MRI增强扫描特征鉴别诊断ICC与HCC的效能。结果在120例PLC患者中,经组织病理学检查诊断ICC者23例和HCC者97例;ICC病灶动脉期边缘强化、动态逐渐强化、肝胆期靶征和远端胆管扩张发生率分别为69.6%、56.5%、65.2%和39.1%,均显著高于HCC病灶的44.3%、17.5%、9.3%和3.1%,而病灶包膜发生率为4.3%,显著低于HCC病灶的45.4%(P＜0.05);综合扫描特征,本组病例经MRI诊断ICC者31例,HCC者89例,其鉴别诊断ICC与HCC的敏感度为78.3%,特异度为86.6%,阳性预测值为58.1%,阴性预测值为94.4%。结论术前,可根据MRI增强扫描特征鉴别ICC与HCC提供帮助,为临床做出合理的处置方案提供依据。

关键词: 肝内胆管细胞癌, 肝细胞癌, 磁共振成像, 特征, 诊断

Abstract: Objective The purpose of this study was to summarize the enhanced magnetic resonance imaging (MRI) feature in differential diagnosis of intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC). Methods 120 patients with primary liver cancer (PLC) were encountered in our hospital between December 2019 and July 2023, and there all underwent enhanced MR scan before hepatectomy. The enhancement MR feature included arterial phase reinforcement characteristics, dynamic reinforcement patterns, abnormal blood perfusion, target sign at hepatobiliary phase, lesion signal form, distal bile duct dilation, and lesion capsule. The receiver operating characteristic curve (ROC) was applied to evaluate the differential diagnostic performance of MRI scanning. Results Out of the 120 patients with PLC, the histo-pathological examination diagnosed ICC in 23 cases and HCC in 97 cases; the percentages of edge of lesion enhancement at arterial phase, gradually dynamic enhancement mode, hepatobiliary target and distal bile duct dilatation in ICC lesions were 69.6%,56.5%, 65.2% and 39.1%, all significantly higher than 44.3%, 17.5%,9.3% and 3.1%, while the percentage of lesion envelope was 4.3%, much lower than 45.4%(P＜0.05) in HCC lesions; based on comprehensive features, the MRI diagnosed ICC in 31 cases and HCC in 89 cases, with the sensitivity of 78.3%, the specificity of 86.6%, the positive predicting value of 58.1% and negative predicting value of 94.4%. Conclusion The enhanced MRI scanning could provide the clues for differentiating the ICC and HCC before surgery, which might help the clinicians make an appropriate management plans.

Key words: Hepatoma, Intrahepatic cholangiocarcinoma, Hepatocellular carcinoma, Magnetic resonance imaging, Feature, Diagnosis

曾旺, 蔡晓曼, 葛尚. 肝内胆管细胞癌与肝细胞癌病灶MRI增强扫描表现差异分析^*[J]. 实用肝脏病杂志, 2024, 27(6): 907-910.

Zeng Wang, Cai Xiaoman, Ge Shang. Enhanced MRI manifestation feature in differential diagnosis of ICC and HCC: A single center study[J]. Journal of Practical Hepatology, 2024, 27(6): 907-910.

参考文献

[1] 韩祥松, 李全伟, 郭佩垒, 等. 两种肝切除方式对肝内胆管细胞性肝癌患者生存结局影响的多因素分析. 中华医学杂志, 2022, 102(18):1364-1368.
[2] 林益坤, 谢朗, 符剑鸣, 等. 肝部分切除联合胆肠吻合术治疗肝内胆管结石患者临床疗效及术后结石复发危险因素分析. 实用肝脏病杂志, 2022, 25(4):591-594.
[3] Kim JH, Joo I, Lee JM. Atypical appearance of hepatocellular carcinoma and its mimickers: how to solve challenging cases using gadoxetic acid-enhanced liver magnetic resonance imaging. Korean J Radiol, 2019,20(7):1019-1041.
[4] Chang AI, Kim YK, Min JH, et al. Differentiation between inflammatory myofibroblastic tumor and cholangiocarcinoma manifesting as target appearance on gadoxetic acid-enhanced MRI. Abdom Radiol (NY), 2019,44(4):1395-1406.
[5] Jiang H, Song B, Qin Y, et al. Diagnosis of LI-RADS M lesions on gadoxetate-enhanced MRI: identifying cholangiocarcinoma-containing tumor with serum markers and imaging features. Eur Radiol, 2021,31(6):3638-3648.
[6] 强泽远, 金帅, 严操, 等. 黏蛋白1、Ki67的表达与肝内胆管细胞癌患者临床病理特征及预后的关系. 中华肝胆外科杂志, 2022, 28(1):33-38.
[7] 刘俊英, 孔鑫, 李涵, 等. 血清和糖皮质激素诱导的蛋白激酶2在肝细胞癌中过表达并介导肝癌细胞中糖原合成酶激酶-3β/β-连环蛋白信号传导. 中华肝脏病杂志, 2020, 28(1):43-46.
[8] Zhou N, Hu A, Shi Z, et al. Inter-observer agreement of computed tomography and magnetic resonance imaging on gross tumor volume delineation of intrahepatic cholangiocarcinoma: an initial study. Quant Imaging Med Surg, 2021,11(2):579-585.
[9] Jin KP, Sheng RF, Yang C, et al. Combined arterial and delayed enhancement patterns of MRI assist in prognostic prediction for intrahepatic mass-forming cholangiocarcinoma (IMCC). Abdom Radiol (NY), 2022,47(2):640-650.
[10] Gao W, Wang W, Song D, et al. A multiparametric fusion deep learning model based on dce-mri for preoperative prediction ofmicrovascular invasion in intrahepatic cholangiocarcinoma. J Magn Reson Imaging, 2022,56(4):1029-1039.
[11] Bashir MR, Chernyak V. Can MRI features of combined hepatocellular carcinoma-intrahepatic cholangiogarcinoma help predict tumor behavior better than histologic findings? Radiology, 2019,290(2):398-399.
[12] Jeon SK, Joo I, Lee DH, et al. Combined hepatocellular cholangiocarcinoma: LI-RADS v2017 categorisation for differential diagnosis and prognostication on gadoxetic acid-enhanced MR imaging. Eur Radiol, 2019,29(1):373-382.
[13] Chen X, Chen Y, Chen H, et al. Machine learning based on gadoxetic acid-enhanced MRI for differentiating atypical intrahepatic mass-forming cholangiocarcinoma from poorly differentiated hepatocellular carcinoma. Abdom Radiol (NY), 2023,48(8):2525-2536.
[14] Kim S, An C, Han K, et al. Gadoxetic acid enhanced magnetic resonance imaging for prediction of the postoperative prognosis of intrahepatic mass-forming cholangiocarcinoma. Abdom Radiol (NY), 2019,44(1):110-121.
[15] Kova JD, Jankovi A, iki-Rom A, et al. Imaging spectrum of intrahepatic mass-forming cholangiocarcinoma and its mimickers: how to differentiate them using MRI. Curr Oncol, 2022,29(2):698-723.
[16] Zhang J, Wu Z, Zhao J, et al. Intrahepatic cholangiocarcinoma: MRI texture signature as predictive biomarkers of immunophenotyping and survival. Eur Radiol, 2021,31(6):3661-3672.
[17] Javle M, Roychowdhury S, Kelley RK, et al. Infigratinib (BGJ398) in previously treated patients with advanced or metastatic cholangiocarcinoma with FGFR2 fusions or rearrangements: mature results from a multicentre, open-label, single-arm, phase 2 study. Lancet Gastroenterol Hepatol, 2021,6(10):803-815.
[18] Zhou Y, Zhou G, Zhang J, et al. DCE-MRI based radiomics nomogram for preoperatively differentiating combined hepatocellular-cholangiocarcinoma from mass-forming intrahepatic cholangiocarcinoma. Eur Radiol, 2022,32(7):5004-5015.
[19] 李炳荣, 张坤, 严小斌, 等. 2018版MRI肝脏影像报告和数据系统对≤3 cm肝细胞癌与其他肝脏原发恶性肿瘤的鉴别诊断价值. 中华放射学杂志, 2021, 55(2):166-172.
[20] Liu Y, Wang B, Mo X, et al. A deep learning workflow for mass-forming intrahepatic cholangiocarcinoma and hepatocellular carcinoma classification based on MRI. Curr Oncol, 2022,30(1):529-544.
[21] Yamada S, Morine Y, Imura S, et al. Prognostic prediction of apparent diffusion coefficient obtained by diffusion-weighted MRI in mass-forming intrahepatic cholangiocarcinoma. J Hepatobiliary Pancreat Sci, 2020,27(7):388-395.

肝内胆管细胞癌与肝细胞癌病灶MRI增强扫描表现差异分析^*

Enhanced MRI manifestation feature in differential diagnosis of ICC and HCC: A single center study

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	张少博, 张树庚, 刘连新. 免疫治疗肝细胞癌肝移植患者现状和前景展望^*[J]. 实用肝脏病杂志, 2024, 27(6): 801-803.
[2]	郑浩, 张树庚, 王嘉倍, 郭亚飞. 肝移植术治疗肝细胞癌患者肿瘤复发再治疗策略^*[J]. 实用肝脏病杂志, 2024, 27(6): 804-807.
[3]	朱泽斌, 张树庚, 刘连新. 靶向和免疫治疗原发性肝癌:肝移植术前降期治疗应用进展^*[J]. 实用肝脏病杂志, 2024, 27(6): 808-811.
[4]	周隽, 张忠新, 徐海燕. 可视化瞬时弹性成像与声触诊弹性成像诊断慢性乙型肝炎患者肝纤维化效能比较^*[J]. 实用肝脏病杂志, 2024, 27(6): 832-835.
[5]	李靖, 何海滨, 李春婷, 石磊. 230例药物性肝损伤患者临床特征分析^*[J]. 实用肝脏病杂志, 2024, 27(6): 870-873.
[6]	武羽, 韩宇星, 徐曼曼, 焦婧然, 杨雪, 段小宛, 陈煜. DRG付费改革背景下慢加急性肝衰竭患者费用盈亏分析^*[J]. 实用肝脏病杂志, 2024, 27(6): 882-886.
[7]	唐敏, 曾理, 杨鑫荣. FibroTouch和声触诊组织量化成像参数评估血吸虫病性肝病患者肝纤维化临床研究^*[J]. 实用肝脏病杂志, 2024, 27(6): 887-890.
[8]	陈思艳, 郭道宁, 邹晓攀, 漆家高. 彩色多普勒超声评估肝硬化门静脉高压症患者TIPS术后支架功能研究^*[J]. 实用肝脏病杂志, 2024, 27(6): 899-902.
[9]	丹巴玉珍, 程盼. 增强MRI检查诊断HCC价值研究^*[J]. 实用肝脏病杂志, 2024, 27(6): 911-914.
[10]	杨佳欣, 杨紫郡, 陈卫. 双源CT双能量TNC技术图像质量与诊断肝细胞癌效能分析^*[J]. 实用肝脏病杂志, 2024, 27(6): 915-918.
[11]	邓娜, 郑玉凤, 刘旭红, 韩晓兵, 丁碧娇, 曾纬阳, 刘娜红, 黄莹, 陈梅桂. CT动态增强扫描诊断原发性肝癌效能分析^*[J]. 实用肝脏病杂志, 2024, 27(6): 919-922.
[12]	马紫瑶, 王超, 赵珏, 冯赟, 张铭, 梁凯轶. MRI诊断不典型肝脓肿临床应用价值分析^*[J]. 实用肝脏病杂志, 2024, 27(6): 931-934.
[13]	伊芬秀, 伊芬锦, 娄仲雷. 2型糖尿病合并细菌性肝脓肿患者临床特征分析^*[J]. 实用肝脏病杂志, 2024, 27(6): 935-938.
[14]	王玲玲, 姚敏, 姚登福. 肝细胞癌进展过程中KLFs异常表达及其检测的临床价值研究进展^*[J]. 实用肝脏病杂志, 2024, 27(6): 953-956.
[15]	韦新焕, 柳雅立, 张晶, 贾继东. 代谢相关性脂肪性肝硬化诊疗进展^*[J]. 实用肝脏病杂志, 2024, 27(5): 641-645.