联合多种MRI参数预测肝内肿块型胆管细胞癌分化程度的研究

Estimating the pathological differentiation of intrahepatic mass-type cholangiocarcinoma by combined multiple MRI parameters

目的探讨联合多种MRI参数在术前判断肝内肿块型胆管细胞癌(IMCC)病理分化程度的价值。方法回顾性分析34例经手术病理证实为IMCC的病人的临床、病理、MRI资料。将病人分为高中分化组(19例)和低分化组(15例),采用t检验或χ^2检验比较2组在MRI表现、平均ADC值(ADCmean)等方面的差异,采用Logistic回归模型分析多参数联合的预测效能并绘制受试者操作特征(ROC)曲线。结果2组间病灶最大径、形状、坏死、包膜皱缩差异均无统计学意义(P>0.05);而2组间淋巴结转移情况、强化方式、ADCmean值的差异有统计学意义(分别为χ^2=5.536,P=0.019;χ^2=9.293,P=0.002;t=3.477,P<0.001)。将淋巴结转移、强化方式及ADCmean纳入Logistic回归模型,3个指标联合预测IMCC分化程度具有较高的准确性,ROC曲线下面积0.861,敏感度80.0%,特异度73.7%。结论淋巴结转移、强化方式及ADCmean是术前预测IMCC分化程度的独立危险因素,联合应用可提高预测效能。

Objective To explore the value of combined multiple MRI parameters in estimating the pathological differentiation of intrahepatic mass-forming type cholangiocarcinoma(IMCC).Methods The clinical,pathological and MRI data of 34 patients with IMCC proved by pathology were retrospectively analyzed.The patients were divided into two groups:well-moderately differentiated group(n=19)and poor differentiated group(n=15).The differences in MRI findings,and mean apparent diffusion coefficient(ADCmean)value between the two groups were compared by t test or χ^2 test.Logistic analysis was used to analyze the predictive ability of combined multi-parameter and receiver operating characteristic(ROC)curve was drawn.Results There was no significant difference in the lesion maximum diameter,shape,necrosis,and capsular contraction between the two groups(P>0.05).However,the differences were significant regarding lymphatic metastasis,enhancement mode,ADCmean value between the two groups(χ^2=5.536,P=0.019;χ^2=9.293,P=0.002;t=3.477,P<0.001).Lymph node metastasis,enhancement pattern,and ADCmean were included in the logistic regression model as the main predictors of IMCC differentiation,combining the three indicators archived high accuracy.The area under the ROC curve was 0.861,the sensitivity of 80.0%,and the specificity of 73.7%.Conclusion Lymph node metastasis,enhancement pattern,and ADCmean are effective indicators for estimating the pathological differentiation of IMCC.The combination of the three indicators has the highest diagnostic efficiency.