钆贝葡胺多期增强MRI对肿块型胆管细胞癌和不典型肝脓肿的鉴别诊断  

Gadobenate Dimeglumine Multi-Phase Enhanced MRI in Differential Diagnosis of Intrahepatic Mass-Forming Cholangiocarcinoma and Atypical Liver Abscess

作　　者：郑婉静 熊美连[1] 陈晓丹[1] 林晓君[1] 曹代荣[1] ZHENG Wanjing;XIONG Meilian;CHEN Xiaodan;LIN Xiaojun;CAO Dairong(Department of Radiology,the First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China)

机构地区：[1]福建医科大学附属第一医院医学影像科,福建福州350005

出　　处：《中国医学影像学杂志》2022年第5期474-479,489,共7页Chinese Journal of Medical Imaging

基　　金：福建省教育厅中青年教师教育科研项目(JAT200167)。

摘　　要：目的探讨钆贝葡胺(Gd-BOPTA)多期增强MRI鉴别诊断肿块型胆管细胞癌(IMCC)与不典型肝脓肿的应用价值。资料与方法回顾性收集2014年12月—2020年4月在福建医科大学附属第一医院治疗的32例IMCC与24例不典型肝脓肿患者的临床及MRI资料,患者均行平扫、扩散加权成像和Gd-BOPTA多期增强扫描,包括肝胆期扫描。比较两组患者的临床特征及MRI表现(肿块形态、T2WI信号、动脉期强化程度、增强扫描三期以及肝胆期强化方式),在肝胆期分别评估病灶边缘和中心的信号特点。使用Logistic回归分析模型筛选出IMCC的独立预测因素,采用受试者工作特征曲线分析各独立因素及其联合预测的效能。结果IMCC和不典型肝脓肿在T2WI囊变区[13(40.6)比13(40.6),χ^(2)=6.557]、扩散加权成像靶环样高信号[9(28.1)比1(4.2)]和肝胆期强化方式(边缘χ^(2)=26.191,中央χ^(2)=18.098)差异有统计学意义(P均<0.05)。多因素Logistic回归分析显示,T2WI少见囊变区、肝胆期病灶边缘低信号和中央持续对比剂填充是诊断IMCC的独立危险因素,曲线下面积分别为0.672、0.818和0.786,联合3项指标的曲线下面积达0.954。结论基于Gd-BOPTA多期增强MRI,尤其是联合肝胆期特征后建立的Logistic模型鉴别诊断IMCC和不典型肝脓肿有一定的价值。Purpose To investigate the value of gadobenate dimeglumine(Gd-BOPTA)multi-phase enhanced MRI in the differential diagnosis of intrahepatic mass-forming cholangiocarcinoma(IMCC)and atypical liver abscess.Materials and Methods The clinical and MRI data of 32 patients with IMCC and 24 patients with atypical liver abscess treated in the First Affiliated Hospital of Fujian Medical University from December 2014 to April 2020 were collected.All patients underwent unenhanced MRI scan,diffusion weighted imaging(DWI)and Gd-BOPTA multi-phase enhanced scan,including hepatobiliary phase(HBP)scan.The clinical features and MRI findings of the two groups were compared.The MRI findings included the shape of the mass,T2WI signal,the degree of enhancement in arterial phase,the enhancement mode in the three phases of enhanced scanning and HBP.The signal characteristics of the edge and center of the lesion were evaluated in HBP.The independent predictors of IMCC were selected by logistic regression analysis and the receiver operating characteristic curve was drawn to evaluate the diagnostic efficacy of different parameters.Results Univariate analysis showed that there were statistically significant differences in T2WI cystic area[13(40.6)vs.13(40.6),χ^(2)=6.557],DWI target-like hyperintensity[9(28.1)vs.1(4.2)]and HBP enhancement pattern(χ^(2)=26.191,18.098)between the two groups(all P<0.05).Multivariate Logistic regression analysis showed that rare cystic area on T2WI,low signal on the edge of hepatobiliary lesions and central continuous centripetal enhancement were independent risk factors for the diagnosis of IMCC,with area under the curve of 0.672,0.818 and 0.786,respectively;and area under the curve of 0.954combining the three indicators.Conclusion The Logistic model established based on Gd-BOPTA multi-phase enhanced MRI,especially in combination with HBP manifestations,has a certain value in the differential diagnosis of IMCC and atypical liver abscess.

关 键 词：胆管细胞癌 肝脓肿 磁共振成像 扩散加权成像 诊断 鉴别 

分 类 号：R575.7[医药卫生—消化系统] R575.4[医药卫生—内科学]