肿块型胆管细胞癌与单发肝转移瘤的MRI鉴别诊断

Differential diagnosis of intrahepatic mass-forming cholangiocarcinoma and isolated hepatic metastasis by MRI

目的:探讨MRI对肿块型胆管细胞癌(IMCC)与单发肝转移瘤(IHM)的鉴别诊断价值。方法:收集弋矶山医院2012年12月~2020年9月临床及影像资料完整的IMCC患者49例和IHM患者58例。观察并记录两组病灶一般资料及MRI平扫特征、强化特征和伴随征象,采用t检验、χ^(2)检验及Fisher确切概率法分析病灶特征差异;将上述结果中P<0.10的特征变量纳入多因素Logistic回归分析并建立模型,采用受试者工作特征(ROC)曲线评价鉴别诊断价值。结果:IMCC组患者病灶最长径,位于肝左叶、边界不清晰、形态不规则、动脉期断环征、肝包膜皱缩、肝内胆管扩张、肝内胆管结石及瘤周卫星灶征象占比均高于IHM组患者(P<0.05),且两组患者在强化方式上差异有统计学意义(P<0.05);多因素Logistic回归分析(向前法)显示,肝内胆管扩张、肝包膜皱缩、动脉期断环征及强化方式b和c是鉴别IMCC与IHM的重要特征(P<0.05),ROC曲线表明联合以上特征建立的模型鉴别价值较高,AUC值0.964(95%CI:0.928~1.000,P<0.001),灵敏度和特异度为95.9%、91.4%。结论:IMCC与IHM的MRI征象互有异同,建立MRI征象的Logistic回归模型对鉴别诊断IMCC与IHM有重要价值。

Objective:To investigate the value of magnetic resonancce imaging(MRI)in differential diagnosis of intrahepatic mass-forming cholangiocarcinoma(IMCC)and isolated hepatic metastasis(IHM).Methods:Forty-nine IMCC and 58 IHM patients with complete clinical and imaging data were included in our hospital between December 2012 and September 2020.The general data,property at plain and enhanced MRI scanning,and accompanying signs were observed and recorded,and the differences of MRI properties were analyzed with t-test,χ^(2) test and Fisher′s exact probability between the two groups.Then the characteristic variables with P<0.01 from the above statistics were included in the multivariate logistic regression model.Receiver operating characteristic(ROC)curve was used to evaluate the value of differential diagnosis.Results:The proportion was higher in IMCC patients than that in IHM patients with respect to the longest diameter of the lesion,location in the left lobe of liver,unclear boundary of the lesion,irregular lesion shape,“broken ring”sign in arterial phase,incidence of hepatic capsule retraction and intrahepatic biliary ductal dilatation,presence of calculi within the intrahepatic bile duct,and peritumoral satellite lesions(all P<0.05),and the difference was significant in the enhancement mode between groups(P<0.05).Multivariate logistic regression analysis(forward method)showed that intrahepatic biliary ductal dilation,hepatic capsule retraction,“broken ring”sign in arterial phase and enhancement mode(b and c)were important characteristics for differentiating IMCC from IHM(P<0.05).ROC curve showed that the model established by the combined features aforementioned had higher value for differential diagnosis of IMCC and IHM,with AUC value of 0.964(95%CI:0.928-1.000,respectively,P<0.001),and sensitivity by 95.9%and specificity by 91.4%.Conclusion:MRI signs are different and homogenous in IMCC and IHM.Logistic regression model established on MIR signs basis can be greatly valuable in differentiating IMCC from IHM.