病变相对长度鉴别肝外胆管浸润型癌与胆管炎的价值  

The application values of the relative length of lesion in differential diagnosis of extrahepatic infiltrating cholangiocarcinoma and cholangitis

作　　者：徐建国[1] 唐光健[2] 彭泰松[1] 南喜文[1] 许志高[1] 曹米兰 王壁昊 于萍 李晓琼 杨慧[1] Xu Jianguo;Tang Guangjian;Peng Taisong;Nan Xiwen;Xu Zhigao;Cao Milan;Wang Bihao;Yu Ping;Li Xiaoqiong;Yang Hui(Department of Medical Imaging,the Third People′s Hospital of Datong City,Datong 037008,China;Department of Medical Imaging,the First Hospital of Peking University,Beijing 100034,China;Central Laboratory,the Third People′s Hospital of Datong City,Datong 037008,China;CT Room,the Fifth People′s Hospital of Datong City,Datong 037006,China)

机构地区：[1]山西省大同市第三人民医院医学影像科,037008 [2]北京大学第一医院影像科,100034 [3]山西省大同市第三人民医院中心实验室,037008 [4]山西省大同市第五人民医院CT室,037006

出　　处：《中华放射学杂志》2020年第10期969-973,共5页Chinese Journal of Radiology

摘　　要：目的探讨肝外胆管病变相对长度鉴别浸润型肝外胆管癌与肝外胆管炎的价值。方法回顾性分析2014年10月至2018年2月山西省大同市第三人民医院,经手术病理证实的24例浸润型肝外胆管癌及23例经临床治疗随访证实的肝外胆管炎症患者资料。所有患者均行上腹部MR和(或)CT增强扫描。以影像表现胆管壁增厚,增强扫描明显强化为病变范围,测量计算病变长度及病变长度/肝外胆管长度比值,并观察偏心性狭窄及受累管腔规则性。采用t检验分析肿瘤组与炎症组病变长度和病变/肝外胆管长比值的差异,采用连续校正χ2检验比较肝外胆管癌组与胆管炎组偏心性病变和不规则病变的差异。应用受试者操作特性曲线分析肝外胆管病变长度/肝外胆管长度比值的诊断效能。结果肝外胆管癌与胆管炎患者的病变长度分别为(22.01±1.86)、(47.36±2.81)mm,病变长度/肝外胆管长度比值分别为0.26±0.02和0.54±0.03,差异均有统计学意义(P均<0.01),肝外胆管长度差异无统计学意义(P>0.05)。病变长度/肝外胆管长度比值诊断肝外浸润型胆管癌的受试者操作特征曲线下面积为0.92,以<0.40为临界值,诊断的灵敏度和特异度分别为87.5%和82.6%。肝外胆管癌与胆管炎患者间病变呈偏心性及病变胆管管腔不规则的分布差异无统计学意义(P>0.05)。结论肝外胆管病变相对长度鉴别浸润型肝外胆管癌与肝外胆管炎症具有较大价值。Objective To evaluate the diagnostic value of relative lesion length in differentiating extrahepatic bile duct infiltrating cholangiocarcinoma with inflammation.Methods From October 2014 to February 2018,24 cases of infiltrating extrahepatic cholangiocarcinomas confirmed operatively and pathologically and 23 cases of extrahepatic bile duct inflammation confirmed clinically from the Third People′s Hospital of Datong City were respectively enrolled in this study.Upper abdomen MR and/or CT image data of all patients were respectively reviewed.The extrahepatic duct wall was defined as wall thickening with obvious enhancement.The length of the lesion was measured.Llesion/Lduct was referred as the ratio of the lengths of lesion to extrahepatic bile duct(common hepatic duct+common bile duct)was calculated.The difference in the average values of Llesion/Lductbetween the cholangiocarcinomas group and inflammation group was analyzed with t test,and the differential diagnostic efficacy of Llesion/Lductratio was analyzed with receiver operating characteristic curve(ROC)test.Results Significant difference was found in the length of lesion between the extrahepatic cholangiocarcinoma group[(22.01±1.86)mm]and the cholangitis group[(47.36±2.81)mm](P<0.01).The average ratio of Llesion/Lductwere 0.26±0.02 for the cholangiocarcinomas group and 0.54±0.03 for the inflammation group,respectively(P<0.01).The area under the ROC curve of Llesion/Lduct in diagnosis of the infiltrating extrahepatic cholangiocarcinomas was 0.92.With<0.40 as cut-off point,the diagnostic sensitivity and specificity were 87.5%and 82.6%,respectively.Conclusion The Llesion/Lductmight be taken as an important diagnostic sign in differentiation between infiltrating extrahepatic cholangiocarcinomas and extrahepatic bile duct inflammation.

关 键 词：胆管肿瘤 体层摄影术 X线计算机 磁共振成像 鉴别 诊断 

分 类 号：R735.8[医药卫生—肿瘤] R657.45[医药卫生—临床医学]