MSCT及MRI对肝门胆管癌可切除性评价的对照研究

The Evaluation of MSCT and MRI in Resectability of Hilar Cholangiocarcinoma

目的探讨多层螺旋CT(MSCT)及MRI对肝门胆管癌(hepatic hilum cholangiocarcinoma,HHC)的分型诊断与可切除性评价的价值。资料与方法搜集经手术病理证实且术前MSCT及MRI均定性诊断为HHC的患者25例,对MSCT轴位图像、多平面重组(MPR)、曲面重组(CPR)及MRI轴位、冠状位图像、磁共振胰胆管成像(MRCP)进行分析,分别评价肿瘤病灶的Bismuth-Corlette分型,并与术中结果进行对照分析。采用配对计数资料的卡方检验比较MSCT及MRI对HHC分型及可切除性评价的情况。结果25例中,Ⅰ型、Ⅱ型、Ⅲa型、Ⅲb型和Ⅳ型分别为2、4、3、9和7例;12例行根治性切除术,其中Ⅰ型、Ⅱ型、Ⅲa型、Ⅲb型和Ⅳ型分别为2、3、1、5和1例。MSCT评价肿瘤病灶的Bismuth-Corlette分型诊断准确性达84%(21/25),MRI诊断准确性达88%(22/25),两种方法的分型结果对照,差异无统计学意义(χ2=0.00,P>0.05)。MSCT及MRI对肿瘤术前可切除性评价与术中评价一致率均为80%(20/25),两种方法对照结果差异无统计学意义(χ2=0.50,P>0.05)。结论对于HHC,MSCT及MRI均能作出较准确的Bismuth-Corlette分型诊断,都可以为肿瘤术前可切除性判断提供重要依据。

Objective To investigate the value of MSCT and MR imaging in evaluating the resectability of hilar cholangiocarcinoma.Materials and Methods 25 patients with surgery and histopathology proved hilar cholangiocarcinoma underwent preoperative MSCT and MRI examinations. The axial images,reformatted MPR and CPR images of MSCT as well as the axial images,coronal images and the MRCP images from MRI were reviewed for Bismuth-Corlette classification of hilar cholangiocarcinoma. MSCT and MRI results were compared with each other and also were compared with the findings in surgery and histopathology. The Bismuth-Corlette classifications from MSCT and MRI and their evaluation for the resectability of different types were analyzed with chi-square tests.Results In the 25 cases,the number of TypeⅠ、Ⅱ、Ⅲa、Ⅲb and Ⅳ patients,according to Bismuth-Corlette classification,were 2,4,3,9 and 7 respectively 12 patients underwent curative resections,among them,2,3,1,5 and 1 patient belonged to TypeⅠ,Ⅱ,Ⅲa,Ⅲb and Ⅳ respectively. The accuracy of MSCT in Bismuth-Corlette classification was 84% （21/25）,and MRI 88% （22/25）,there was no significant difference between MSCT and MRI in evaluating Bismuth-Corlette classification of hilar cholangiocarcinoma（χ2=0.00,P0.05）.The accuracy of MSCT and MRI in evaluating the curative respectability of hilar cholangiocarcinoma preoperatively were both 80%（20/25）.There was no significant difference between them（χ2=0.50,P0.05）.Conclusion MSCT and MRI can make accurate diagnosis of Bismuth-Corlette classification and are helpful in assessment of hilar cholangiocarcinoma preoperative respectability.