CT和MRI对肝囊型包虫病分型与活性的评价

Evaluation of computer tomography and magnetic resonance imaging in the classification and viability of hepatic cystic echinococcosis

目的探讨计算机体层成像衰减值(computer tomography attenuation value,CT attenuation value)和磁共振成像(magnetic resonance imaging,MRI)表观扩散系数值(apparent diffusion coefficient,ADC)对肝囊型包虫病(hepatic cystic echinococcosis,HCE)分型与活性的应用价值。材料与方法回顾性分析2016年1月至2019年12月同时通过CT检查和MRI扩散加权成像技术检测181例经手术病理证实的227个肝囊型包虫病的CT值及ADC值,分别对各型病灶囊液进行测量,计算5型肝囊性包虫的CT值及ADC值,利用方差分析和秩相关检验,比较各型之间的差异及相关性。结果根据WHO分型标准,其中CE1:51例、CE2:47例、CE3:50例、CE4:52例、CE5:27例。5型囊性病灶的CT值和ADC值分别为:CE1型(4.79±1.70)HU和(3.25±0.31)×10^(-3)mm^(2)/s、CE2型(6.02±2.53)HU和(3.18±0.15)×10^(-3)mm^(2)/s、CE3型(22.96±4.82)HU和(2.57±0.25)×10^(-3)mm^(2)/s、CE4型(35.30±17.80)HU和(2.40±0.12)×10^(-3)mm^(2)/s、CE5型(108.77±51.02)HU和(2.13±0.68)×10^(-3)mm^(2)/s,其中,CE3、CE4、CE5与CE1、CE2比较,CT值均增高(P<0.05);CE1、CE2、CE4、CE5的ADC值之间两两比较差异有统计学意义(P<0.05);CT值和ADC值之间呈负相关(r=-0.835)。结论本研究同时利用CT值、ADC值定量指标,更加精准地诊断肝囊型包虫病各型病灶活性,根据各型病灶CT值和ADC值的不同,可间接反映病灶生长的活性,从而为临床手术方案的制定提供一定的参考。

Objective:We aimed to explore the value of CT and apparent diffusion coefficient(ADC)in the classification and viability of hepatic cystic echinococcosis(HCE).Materials and Methods:A total of 181 HCE patients with 227 hydatids confirmed by surgery and pathology were admitted in hospital from January 2016 to December 2019.All patients experienced preoperative CT and MRI scans,and CT and ADC values of hydatid fluid were measured and analyzed.The differences and correlations among the types were compared through variance analysis and rank correlation test.Results:According to WHO classification,cyst fluid in 51 lesions of CE1 type,47 lesions of CE2 type,50 lesions of CE3 type,52 lesions of CE4 type and 27 lesions of CE5 type were measured.The mean CT and ADC values of the 5 types of cystic lesions were:CE1(4.79±1.70)HU and(3.25±0.31)×10^(-3) mm^(2)/s,CE2(6.02±2.53)HU and(3.18±0.15)×10^(-3) mm^(2)/s,CE3(22.96±4.82)HU and(2.57±0.25)×10^(-3) mm^(2)/s,CE4(35.30±17.80)HU and(2.40±0.12)×10^(-3) mm^(2)/s,and CE5(108.77±51.02)HU and(2.13±0.68)×10^(-3) mm^(2)/s,respectively.The CT values of CE3,CE4 and CE5 were significantly higher than those in CE1 and CE2(P<0.05).The ADC values of CE1,CE2,CE4 and CE5 were statistically different in pairwise comparison(P<0.05).CT value and ADC value were obviously and negatively correlated(r=-0.835).Conclusions:CT value and ADC value were used as quantitative indicators to more accurately diagnose the activity of various lesions.CT and ADC values could be valuable imaging biomarkers for the viability of HCE,and it can provide some reference for the formulation of clinical operation plan.