64层螺旋CT在肝内胆管细胞癌术前分期中的应用

Application of 64-slice CT in the Preoperative Staging of Intrahepatic Cholangiocarcinoma

目的探讨64层螺旋CT在肝内胆管细胞癌(ICC)术前分期中的应用价值。资料与方法回顾性分析42例经术后病理或穿刺活检证实的肝内胆管细胞癌临床、病理及CT资料。应用一致性检验分析肝内胆管细胞癌64层螺旋CT分期与临床病理分期吻合程度。结果 42例中,CT分期Ⅰ期8例,Ⅱ期7例,Ⅳa期10例,Ⅳb期17例;临床病理分期Ⅰ期12例,Ⅱ期6例,Ⅳa期11例,Ⅳb期13例。CT对T、N、M分期及对血管侵犯的阳性预测值、正确率分别为T(T189%、T275%、T3100%、T4100%)、86%(36/42),N81%、88%(37/42),M76%、90%(38/42),血管85%、95%(40/42)。对比肝内胆管细胞癌临床病理分期,CT对T、N、M分期及对血管侵犯判断的Kappa值分别为0.780、0.759、0.795、0.884。结论肝内胆管细胞癌64层螺旋CT分期与临床病理分期具有很好的一致性,术前CT分期有利于肝内胆管细胞癌的诊断。

Purpose To investigate the value of 64-slice CT in preoperative staging of intrahepatic cholangiocarcinoma （ICC）.Materials and Methods The clinicopathological information and CT images of 42 patients with ICC confirmed pathologically were retrospectively analyzed.The accordance of ICC staging between 64-slice CT and clinicopathological evaluation was analyzed with Kappa test.Results Out of the 42 patients,CT classified stage Ⅰ （n=8）,Ⅱ （n=7）,Ⅳ a （n=10）,and Ⅳ b （n=17）,respectively.Whereas,there were stage Ⅰ （n=12）,Ⅱ （n= 6）,Ⅳ a （n=11） andⅣ b （n=13） defined based on clinicopathology staging system.The positive predictive value and total accuracy rate in T,N,M and accurate description of vessel invasion based on CT staging was T （T1 89%,T2 75%,T3 100%,T4 100%）,86% （36/42）;N 81%,88% （37/42）;M 76%,90% （38/42）;and vessel 85%,95% （40/42）,respectively.The Kappa values of T,N,M and vessel invasion description between contrast CT evaluation and clinicopathological evaluation were 0.780,0.759,0.795 and 0.884,respectively.Conclusion There is a good accordance between CT evaluation and clinicopathological evaluation in staging of ICC.Preoperative staging of ICC with 64-slice CT is helpful for the diagnosis.