增强CT瘤内动脉鉴别肝内胆管细胞癌和低分化肝细胞癌的价值  

Contrast-enhanced CT imaging in distinguishing intrahepatic cholangiocarcinoma from poorly differentiated hepatocellular carcinoma

作　　者：杨翠翠[1,2] 杨慧[3] 郭沐洁[4] 李万湖[5] 吴玉芬[1] 

机构地区：[1]山东省医学科学院附属医院CT室,山东省济南市250031 [2]济南大学山东省医学科学院医学与生命科学学院,山东省济南市250022 [3]泰山医学院附属医院CT室,山东省泰安市271000 [4]济宁医学院附属医院CT室,山东省济宁市272129 [5]山东省肿瘤医院MR室,山东省济南市250117

出　　处：《世界华人消化杂志》2015年第29期4725-4732,共8页World Chinese Journal of Digestology

基　　金：济宁市科技发展计划基金资助项目;No.2014jnyyf03;山东省医学科学院面上基金资助项目;No.2014-10~~

摘　　要：目的:探讨动态增强计算机断层扫描(computed tomography,CT)的影像特征对肝内胆管细胞癌和低分化肝细胞癌的鉴别价值.方法:回顾性分析68例行动态增强CT扫描并经病理证实为肝内胆管细胞癌患者28例、低分化肝细胞癌患者40例的临床资料及影像学资料.结果:单因素分析显示分叶征(P=0.010)、肝内胆管扩张(P=0.031)、肿瘤内肝动脉(P=0.020)、环形强化(P=0.002)、延迟强化(P=0.021)、迅速廓清(P<0.001)征象在肝内胆管细胞癌组和低分化肝细胞癌组较差异有统计学意义(P<0.05).Logistic回归多因素分析显示肿瘤内肝动脉征象是肝内胆管细胞癌重要的独立预测因素(P=0.026),13例(46.43%)病例显示此征象.迅速廓清征象在低分化肝细胞癌的重要识别征象(P=0.015),25例(62.5%)病例显示此征象.结论:动态增强CT中瘤内动脉征象是肝内胆管细胞癌的重要识别因素,而迅速廓清则支持低分化肝细胞癌的诊断.准确的影像学诊断为及时制定合理的治疗方案提供客观依据.AIM：To evaluate the contrast-enhanced computed tomography（CT） features in differentiating intrahepatic cholangiocarcinoma（ICC） from poorly differentiated hepatocellular carcinoma（p-HCC）.METHODS：Sixty-eight patients with pathologically confirmed ICC（n = 28） or p-HCC（n = 40） were enrolled.The clinical and imaging features were investigated retrospectively.RESULTS：Univariate analysis showed that lobulated shape（P = 0.010）,bile duct dilation（P = 0.031）,intratumoral artery（P =0.020）,rim enhancement（P = 0.002）,delayed enhancement（P = 0.021） and quick washout（P〈0.001） were associated with the differences between ICC and p-HCC.Multivariate logistic regression analysis revealed that intratumoral artery was a significant,independent predictive factor of ICC（P = 0.026）,with 13（46.43%） ICCs showing this feature.Quick washout significantly favored p-HCC（P =0.015）,and 25 p-HCCs（62.5%） showed this feature.CONCLUSION：The presence of an intratumoral artery in the arterial phase on contrast-enhanced dynamic CT is an important factor for predicting ICC,while a quick washout is a predictable finding for p-HCC.Accurate imaging diagnosis between ICC and p-HCC can provide an objective basis for making reasonable,timely treatment.

关 键 词：肝内胆管细胞癌 瘤内动脉 肝细胞癌 增强CT 鉴别诊断 

分 类 号：R735[医药卫生—肿瘤] R730.44[医药卫生—临床医学]