CT和MRI诊断肝细胞癌合并胆管癌栓与肝内胆管癌的价值  

The Value of CT and MRI in Diagnosing Hepatocellular Carcinoma with Bile Duct Tumor Thrombi and Intrahepatic Cholangiocarcinoma

作　　者：敖波 钟钢 宁燕 AO Bo;ZHONG Gang;NING Yan(Department of Radiology,the Second People's Hospital of Yichun City,Yichun 336000,China;不详)

机构地区：[1]宜春市第二人民医院放射科,江西宜春336000 [2]宜春市第二人民医院介入室,江西宜春336000 [3]宜春市第二人民医院手术室,江西宜春336000

出　　处：《中国医学创新》2024年第31期145-150,共6页Medical Innovation of China

摘　　要：目的:探讨CT和MRI诊断肝细胞癌合并胆管癌栓(hepatocellular carcinoma bile duct tumor thrombi,HCCBDTT)与肝内胆管癌(intrahepatic cholangiocarcinoma,ICC)的价值。方法:选取2021年1月—2023年12月在宜春市第二人民医院诊断的HCCBDTT患者46例和ICC患者54例进行研究。所有病例均作MRI及CT检查。比较两组患者的MRI和CT征象,分析CT、MRI单独和联合检查的诊断效能。结果:CT显示,HCCBDTT组在动脉期影像中更常见高密度表现,而ICC组则主要为低密度(P<0.05)。HCCBDTT组有更高比例的均匀密度表现(P<0.05)。在增强模式方面,HCCBDTT组以快进快退为主,而ICC组则主要表现为慢进慢退(P<0.05)。MRI征象的T_(1)WI常规增强扫描信号等征象差异显著,ICC组绝大多数是高信号,而HCCBDTT组主要表现为低信号,且HCCBDTT组相较于ICC组有更高的均匀信号表现(P<0.05)。CT检查确诊HCCBDTT 38例,ICC 47例,敏感度、特异度、准确度分别为82.61%、87.04%、85.00%。MRI检查确诊HCCBDTT 40例,ICC 51例,敏感度、特异度、准确度分别为86.96%、94.44%、91.00%。CT联合MRI确诊HCCBDTT 45例,ICC 53例,敏感度、特异度、准确度分别为97.83%、98.15%、98.00%,均高于单独CT、MRI检查。结论:CT联合MRI对HCCBDTT和ICC诊断准确率较高,且较CT和MRI检查手段的单独应用更为精准。Objective:To investigate the value of CT and MRI in the diagnosis of hepatocellular carcinoma bile duct tumor thrombi(HCCBDTT)and intrahepatic cholangiocarcinoma(ICC).Method:A total of 46 patients with HCCBDTT and 54 patients with ICC diagnosed in the Second People's Hospital of Yichun City from January 2021 to December 2023 were selected for the study.All cases underwent MRI and CT examinations.The MRI and CT signs of the two groups were compared,and the diagnostic efficacy of CT and MRI alone and combined were analyzed.Result:CT showed that high density was more common in HCCBDTT group,while low density was more common in ICC group(P<0.05).HCCBDTT group had a higher proportion of uniform density(P<0.05).In terms of enhancement mode,the HCCBDTT group mainly showed fast advance and fast retreat,while the ICC group mainly showed slow advance and slow retreat(P<0.05).The conventional enhanced T_(1)WI scanning signals of MRI signs showed significant differences,the ICC group showed mostly high signals,while the HCCBDTT group showed mainly low signals,and the HCCBDTT group showed higher uniform signal performance than the ICC group(P<0.05).CT examination confirmed 38 cases of HCCBDTT and 47 cases of ICC,with sensitivity,specificity and accuracy of 82.61%,87.04%and 85.00%,respectively.MRI confirmed 40 cases of HCCBDTT and 51 cases of ICC,with sensitivity,specificity and accuracy of 86.96%,94.44%and 91.00%,respectively.CT combined with MRI confirmed 45 cases of HCCBDTT and 53 cases of ICC.The sensitivity,specificity and accuracy were 97.83%,98.15%and 98.00%,respectively,which were higher than that of CT and MRI alone.Conclusion:CT combined with MRI has higher diagnostic accuracy for HCCBDTT and ICC,and is more accurate than the single application of CT and MRI.

关 键 词：MRI影像学 CT检查 肝细胞癌合并胆管癌栓 肝内胆管癌 

分 类 号：R735.7[医药卫生—肿瘤] R735.8[医药卫生—临床医学]