肝内胆管细胞癌与不典型肝脓肿的MRI、CT、DWI鉴别诊断特征  

Differential diagnosis features of intrahepatic cholangiocarcinoma and atypical liver abscess by MRI,CT and DWI

作　　者：陈秀琴[1] 柏劲松 CHEN Xiu-qin;BO Jin-song(Radiology Department,Hanzhong People's Hospital,Hanzhong 723000,China)

机构地区：[1]汉中市人民医院放射科,陕西汉中723000

出　　处：《临床医学研究与实践》2020年第16期111-113,共3页Clinical Research and Practice

摘　　要：目的探讨肝内胆管细胞癌与不典型肝脓肿的MRI、CT、DWI鉴别诊断特征。方法选择2017年1月至2019年10月就诊于我院的85例疑似肝内胆管细胞癌或不典型肝脓肿患者,对患者实施CT、MRI、DWI检查,以病理穿刺活检结果为参照,比较CT、MRI、DWI对肝内胆管细胞癌、不典型肝脓肿的诊断结果,分析肝内胆管细胞癌患者与不典型肝脓肿患者的MRI表现和表观弥散系数(ADC)值。结果MRI、DWI诊断肝内胆管细胞癌的灵敏度、特异度、准确率均高于CT(P<0.05),而MRI与DWI的灵敏度、特异度、准确率无显著差异(P>0.05)。CT与病理穿刺活检诊断结果具有中度一致性(Kappa值=0.572),MRI、DWI与病理穿刺活检诊断结果具有高度一致性(Kappa值=0.739、0.824)。在MRI图像中,肝内胆管细胞癌患者与不典型肝脓肿患者的囊变区、动脉期环形强化、动脉期断环征比较,差异均具有统计学意义(P<0.05),而两者的肝周积液、肝肿大、肝内胆管扩张无显著差异(P>0.05)。肝内胆管细胞癌患者在不同b值下的ADC值均低于不典型肝脓肿患者,差异均具有统计学意义(P<0.05)。结论MRI对肝内胆管细胞癌、不典型肝脓肿均具有良好的诊断价值,尤其是磁共振DWI技术,可对肝内胆管细胞癌与不典型肝脓肿进行准确的鉴别区分。Objective To explore the differential diagnosis features of intrahepatic cholangiocarcinoma and atypical liver abscess by MRI,CT and DWI.Methods From January 2017 to October 2019,85 cases suspected intrahepatic cholangiocarcinoma or atypical liver abscess who treated in our hospital were selected and examined by CT,MRI and DWI.Based on the results of pathological biopsy,the diagnosis results of intrahepatic cholangiocarcinoma and atypical liver abscesses by CT,MRI and DWI were compared,MRI performance and apparent diffusion coefficient(ADC)value of patients with intrahepatic cholangiocarcinoma and atypical liver abscess were analyzed.Results The sensitivity,specificity and accuracy of MRI and DWI in the diagnosis of intrahepatic cholangiocarcinoma were higher than those of CT(P<0.05),but there were no significant differences in the sensitivity,specificity and accuracy between MRI and DWI(P>0.05).The results of CT and pathological biopsy were moderate consistent(Kappa value=0.572),MRI,DWI and pathological biopsy were highly consistent(Kappa value=0.739,0.824).In the MRI images,there were statistically significant differences in cystic area,ring enhancement in arterial phase and ring breaking in arterial phase between patients with intrahepatic cholangiocarcinoma and atypical liver abscess(P<0.05),but there were no significant differences in perihepatic effusion,hepatomegaly and intrahepatic cholangiectasis between the two groups(P>0.05).The ADC value at different b values of patients with intrahepatic cholangiocarcinoma were lower than those of patients with atypical liver abscess,and the differences were statistically significant(P<0.05).Conclusion MRI has good diagnostic value for intrahepatic cholangiocarcinoma and atypical liver abscess,especially magnetic resonance DWI technology,which can accurately distinguish intrahepatic cholangiocarcinoma and atypical liver abscess.

关 键 词：肝内胆管细胞癌 不典型肝脓肿 MRI CT DWI 

分 类 号：R735.7[医药卫生—肿瘤]