磁共振多模态成像对肝泡型包虫病的术前评价

Preoperative Evaluation of Hepatic Alveolar Echinococcosis by Magnetic Resonance Multimodal Imaging

目的:运用MR成像技术全面评估肝泡型包虫病(HAE)患者病灶部位、大小、类型、边缘带活性、血管受侵及胆管受侵情况,为临床治疗提供影像学依据。方法:收集2015年—2019年我院确诊为肝泡型包虫病的150例患者,行1.5T MRI常规扫描、DWI、MRCP、胆道重建、DCE-MRI及血管成像,收集其影像资料,判断病灶的部位、大小、类型、边缘带活性、血管侵犯及胆管侵犯情况,并与术中结果和ERCP结果进行比较。结果:HAE患者的病灶边缘带与正常肝组织的ADC值分别为(1.11±0.09)×10^(-3)mm^(2)/s、(1.46±0.08)×10^(-3)mm^(2)/s,差异具有统计学意义(P <0.05);HAE患者DCE-MRI结果与病理结果比较,一致性检验Kappa值分别为0.742、0.855、0.874;MRCP对HAE患者胆管损害诊断的灵敏度、特异度及AUC分别为0.821、0.778、0.799。结论:MRI可以全面评估肝泡型包虫病病灶的累及范围、边缘带活性、血管及胆管受侵情况,可对肝泡型包虫病临床治疗及术前评估提供指导。

Objective:Objective to comprehensively evaluate the location,size,type,Fringe band activity,vascular invasion and bile duct invasion of(Hepatic alveolar echinococcosis,HAE)by MR imaging technology,which can provide imaging evidence for clinical treatment.Methods:150 HAE patients with hepatic alveolar echinococcosis(HAE)confirmed in our hospital were all scanned with 1.5 T MR,the sequence include MRI routine,DWI,ADC,Magnetic resonance cholangiopancreatography,biliary reconstruction,dynamic contrast and angiography.The imaging data was used to judge the location,size,type,Fringe band activity,vascular invasion,and bile duct invasion of the lesion,compared with intraoperative and MRCP.Results:Results The ADC value of marginal band in patients with HAE and normal liver tissue’s were(1.11±0.09)×10^(-3)mm^(2)/s,(1.46±0.08)×10^(-3)mm^(2)/s,the difference was statistically significant(P < 0.05);DCE-MRI in HAE patients results were compared with pathological results,the consistent Kappa values were 0.742,0.855 and 0.874.The MRCP sensitivity,specificity,and AUC about the diagnosis of bile duct damage in HAE patients were 0.821,0.778 and 0.799.Conclusion:MRI can comprehensively evaluate the extent of HAE,the involvement of vascular and bile ducts.It can provide guidance for clinical surgical treatment and preoperative evaluation of HAE.