基于LI-RADS添加辅助MRI征象鉴别不典型肝细胞癌与肝内胆管细胞癌  

Added auxiliary signs to differentiate atypical hepatocellular carcinoma from mass intrahepatic cholangiocarcinoma based on the liver imaging reporting and data system

作　　者：张庆[1] 李云[1] 熊浩[1] 彭婕[1] ZHANG Qin;LI Yun;XIONG Hao(Department of Radiology,Jingzhou No 1 People′s Hospitaland First Affiliated Hospital of Yangtze University,Hubei 434000,China)

机构地区：[1]长江大学附属荆州市第一人民医院放射科,湖北荆州434000

出　　处：《放射学实践》2023年第12期1581-1586,共6页Radiologic Practice

摘　　要：目的:探讨基于2018版肝脏影像报告和数据系统(LI-RADS)添加MRI辅助征象对不典型肝细胞癌(HCC)与肿块型肝内胆管细胞癌(ICC)的鉴别诊断价值,明确Gd-EOB-DTPA增强MRI鉴别LR-M患者中HCC和ICC的可靠影像学特征。方法:回顾性搜集2017年6月-2022年8月在本院行Gd-EOB-DTPA增强MRI检查的LR-M类肝脏肿瘤患者的病例资料。其中,不典型HCC 42例,ICC 56例。基于2018版LI-RADS中主要MRI征象和添加辅助MRI征象对不典型HCC与ICC的影像表现进行比较。采用多元logistic回归分析筛选出诊断HCC的独立影响因素。基于LI-RADS中诊断HCC的主要MRI征象建立HCC诊断模型(模型A)并分析其诊断效能,在模型A的基础上添加辅助征象建立HCC诊断模型(模型B)并分析其诊断效能,采用DeLong检验比较模型A和模型B的AUC的差异。结果:不典型HCC与ICC血清甲胎蛋白(AFP)和CA-199的差异具有统计学意义(P<0.001;P=0.008),强化包膜(P=0.001)、病灶内出血(P=0.040)、脂质沉积(P=0.036)、马赛克征(P=0.002)、圆形或类圆形(P=0.034)、瘤内分隔(P=0.003)和小范围中央肝胆期(HBP)高信号(P<0.001)在HCC组中更常见;而HBP靶征(P=0.024)、瘤周胆管扩张(P=0.013)、EOB云征(P<0.001)和大范围中央HBP高信号(P<0.001)在ICC组中更常见。多元Logistic回归分析结果显示AFP水平升高、包膜强化、瘤内分隔和小范围HBP中央高信号是HCC的高危因素。模型A诊断HCC的ROC曲线下面积(AUC)为0.839,敏感度为85.7%,特异度为78.6%;模型B的AUC为0.900,敏感度为76.2%,特异度为87.5%。DeLong检验结果显示模型B的AUC高于模型A(P=0.009)。结论:包膜强化是诊断HCC的可靠征象,基于LI-RADS添加辅助征象能够提高对不典型HCC与ICC的鉴别诊断准确性。Objective:To explore the value of added auxiliary signs to differentiate atypical hepatocellular carcinoma(HCC)from mass intrahepatic cholangiocarcinoma(ICC)based on the 2018 version liver imaging reporting and data system(LI-RADS),and the reliable imaging features of gadoli-nium-ethoxybenzyl-diethylenetriaminepentaacetic acid(Gd-EOB-DTPA)enhanced MRI for distinguishing HCC and ICC in patients with LR-M hepatic lesion.Methods:Retrospective analysis of patients with LR-M liver tumors who underwent Gd-EOB-DTPA MRI examination in our hospital from July 2017 to August 2022,including 42 cases of atypical HCC and 56 cases of ICC.The imaging features of atypical HCC and ICC were compared based on LI-RADS main features(model A)and added auxiliary MRI signs(model B).The high risk factors for the diagnosis of atypical HCC were selected by multiple logistic regression analysis.HCC diagnostic model A was established based on the main characte-ristics of LI-RADS and the diagnostic efficacy was analyzed.On the basis of model A,auxiliary signs were added to establish HCC diagnostic model B and the diagnostic efficacy was analyzed,and the difference in AUCs between model A and model B were compared by DeLong test.Results:There were significant differences in serum AFP and CA-199 between atypical HCC and ICC(P<0.001 and P=0.008,respectively).The MRI features of enhanced capsule(P=0.001),intralesional hemorrhage(P=0.040),lipid deposition(P=0.036),mosaic sign(P=0.002),round or quasi-round(P=0.034),intratumoral septal(P=0.003),and small central HBP(hepatobiliary phase)hyperintensity(P<0.001)were more common in HCC group;and the MRI features of HBP target sign(P=0.024),peritumoral bile duct dilatation(P=0.013),EOB cloud sign(P<0.001)and large central HBP hyperintensity(P<0.001)were more common in ICC group.Multivariable logistic regression analysis showed that increased AFP level,capsular enhancement,intratumoral septum,and small HBP central hyperintensity were high risk factors for HCC.The area under curve of model A for HCC diagnos

关 键 词：肝脏影像报告和数据系统 肝细胞癌 胆管细胞癌 诊断效能 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学] R735.7[医药卫生—诊断学]