混合型肝癌的增强模式分析及超声造影联合增强CT/MRI及肿瘤标志物的诊断价值

Analysis of enhancement patterns and combined diagnosis of combined hepatocellular-cholangiocarcinoma:CEUS,CECT/MRI and tumor markers

目的比较混合型肝癌(combined hepatocellular-cholangiocarcinoma,CHC)在超声造影(contrast enhanced ultrasonography,CEUS)和增强CT/磁共振成像(contrast enhanced computed tomography/magnetic resonance imaging,CECT/MRI)中增强模式的差异并探究影像学与影像学、影像学与肿瘤标志物以及肿瘤标志物之间的差异性表现对CHC检出的提示作用。方法回顾性分析2011年7月至2019年8月天津市第三中心医院35例病理确诊的CHC患者的临床资料,对病灶在CEUS和CECT/MRI中增强模式进行比较。联合病灶在CEUS和CECT/MRI中的差异性增强模式、影像增强模式与肿瘤标志物的差异性表现以及肿瘤标志物之间的差异性表现用于CHC检出。结果病灶在CEUS上表现为肝细胞癌(hepatocellular carcinoma,HCC)及肝内胆管细胞癌(intrahepatic cholangiocellular carcinoma,ICC)增强模式的比例为62.9%和37.1%;在CECT/MRI上表现为HCC、ICC及CHC增强模式的比例为48.6%、31.4%和20.0%。12例直径≤3.0 cm病灶在CEUS表现为HCC增强模式的比例为100%,在CECT/MRI表现为HCC和ICC增强模式的比例为91.7%和9.3%;23例直径>3 cm病灶在CEUS表现为HCC和ICC增强模式的比例为43.5%和56.5%,在CECT/MRI表现为HCC、ICC及CHC增强模式的比例为26.1%、43.5%和30.4%。以CEUS和CECT/MRI增强模式不一致、肿瘤标志物与影像学不一致、AFP和CA19-9同时升高作为提示性诊断信息,78.6%的患者至少符合上述3种差异性表现中的1种。结论CHC在CEUS及CECT/MRI中的增强模式具有差异性。随着病灶直径增加,CHC在增强影像中的表现均由类HCC转变为类ICC或CHC。联合CEUS和CECT/MRI差异性增强模式、影像学与肿瘤标志物之间的差异性表现以及肿瘤标志物的差异表现有助于提高CHC的检出率。

Objective To compare enhancement patterns of combined hepatocellular-cholangiocarcinoma(CHC)in CEUS and CECT/MRI and to explore the role of imaging,the discordance of imaging findings and tumor markers,differences in tumor markers in the diagnosis of CHC.Methods Thirty-five CHCs from July 2011 to August 2019 in Third Central Hospital of Tianjin confirmed by pathological diagnosis were retrospectively reviewed.The enhancement patterns of CHCs on CEUS and CECT/MRI were compared.A combination of the discordance of CEUS and CECT/MRI,the discordance of elevated tumor markers and imaging findings and the discordance of tumor markers was applied to diagnose CHC.Results About 62.9%and 37.1%lesions showed the HCC and ICC enhancement patterns on CEUS,while 48.6%,31.4%and 20%lesions showed the HCC,ICC and CHC enhancement patterns,on CECT/MRI,respectively.For 12 lesions with a diameter≤3.0 cm,all of which presented HCC enhancement patterns on CEUS,and 91.7%lesions showed HCC enhancement pattern and 9.3%lesions showed ICC enhancement pattern on CECT/MRI,respectively.For 23 lesions with a size>3.0 cm,43.5%and 56.5%of which showed the HCC and ICC enhancement patterns on CEUS,respectively.And 26.1%,43.5%and 30.4%of the lesions showed the HCC,ICC and CHC enhancement patterns on CECT/MRI,respectively.If the discordance of CEUS and CECT/MRI,the discordance of image features and tumor markers,or simultaneous elevation of AFP and CA19-9,were used as diagnostic information,78.6%of the lesions met at least one of the three criteria.Conclusions CHCs show different enhancement patterns on CEUS and CECT/MRI.With the increase of size of tumors,the enhancement patterns of CHCs have changed from HCC-like to ICC-like or CHC-like.Combination of the discordance of CEUS and CECT/MRI,the discordance of imaging findings and tumor markers and differences in tumor markers can improve the detection rate of CHCs.