MRI动态增强与多层螺旋CT增强扫描对肝外胆管癌术前分期的评价  

Role of dynamic scanning by multi-slice CT and enhanced scanning by MRI in preoperative staging for extrahepatic cholangiocarcinoma

作　　者：崔兴宇[1] 任克[1] 孙文阁[1] 王强[1] 韩敏[1] 郭克建[1] 刘永峰[1] 徐克[1] 

机构地区：[1]中国医科大学附属第一医院放射科,沈阳110001

出　　处：《中华肝胆外科杂志》2009年第5期329-332,共4页Chinese Journal of Hepatobiliary Surgery

摘　　要：目的对比分析MRI动态增强与多层螺旋CT（MSCT）增强扫描评估肝外胆管癌术前分期的准确性及临床应用价值。方法回顾性分析经病理证实的肝外胆管癌77例，60例行多层螺旋CT增强扫描，33例行肝脏三维容积超快速多期动态增强扫描（liver acquisition with volume acceleration，LAVA）序列检查，其中16例同时做过此两种检查。根据肿瘤的形态、胆管浸润范围，肝动脉、门静脉血管受累情况，有无腹腔内器官、淋巴结转移等指征，进行TNM分期，并与病理结果对照。结果所有的原发肿瘤均被MRI动态增强扫描检出（100％），60例肝外胆管癌原发肿瘤MSCT增强扫描检出52例（86．7％）。MSCT增强扫描T分期的总准确性65％（39／60），MRI动态增强检查是93．9％（31／33）（P〈0．05）。MSCT增强与MRI动态增强扫描的N分期总准确性分别为55％（33／60）、81．8％（27／33）（P〈0．05）。两者的M分期总准确性分别为i00％（33／33）、96．7％（58／60）（P〉0．05）。结论在肝外胆管癌原发肿瘤病灶检出及TNM分期准确性上，MRI动态增强扫描优于MSCT增强扫描。Objective To evaluate the accuracy of dynamic scanning by multi-slice computed tomography （MSCT） and enhanced scanning by magnetic resonance images（MRI） for preoperative staging of extrahepatic cholangiocarcinoma （EHCC）. Methods Seventy-seven patients with surgically proven EHCC were reviewed retrospectively. Sixty cases underwent dynamic MSCT. 3-dimensional contrast-enhanced dynamic magnetic resonance images （3D CE MRI） were obtained in thirty - three patients, both CT and MRI dynamic enhancement were performed in 16 cases. The radial extent （TNM staging） and the vertical extent of tumors were assessed and their correlation with pathological findings of surgical specimen analyzed. Results All of primary tumors were detected by 3-dimensional contrast-enhanced dynamic magnetic resonance imaging （100 %）, and 52 of 60 cases with extrahepatic EHCC detected by dynamic MSCT（86.7 %）. The overall accuracy of the T staging was 65%（39/60） with dynamic MSCT and 93.9% （31/33）with contrast-enhanced dynamic magnetic resonance imaging （P〈0. 05）. The overall accuracy of N staging was 55% （33/60） with CT and 81.8% （27/33） with MRI （P（0.05）. The overall accuracy of M staging was 100% （33/33） and 96.7% （58/60） （P〉 0.05）respectively. Conclusion 3D CE MRI is more valuable than dynamic MDCT in detection of primary tumors and the accuracy for TNM staging of EHCC.

关 键 词：胆管肿瘤 造影剂 体层摄影术 X线计算机 磁共振成像 

分 类 号：R686[医药卫生—骨科学]