CT联合MRI检查对肝门部胆管癌的诊断价值分析

Analysis of the Diagnostic Value of CT Combined with MRI in Hilar Cholangiocarcinoma

目的探讨CT联合磁共振(MRI)检查对肝门部胆管癌(HCCA)的诊断价值。方法选取2017年12月至2018年12月于我院就诊治疗的58例HCCA患者作为研究对象,以手术病理学检查结果为标准,比较不同检查方法对HCCA的诊断符合率,并分析HCCA在不同影像学检查中的图像表现。结果 CT联合MRI对HCCA的诊断符合率(98.28%)显著高于CT(62.07%)和MRI(82.76%),MRI诊断符合率显著高于CT(P<0.05);CT和MRI中,HCCA均可表现为肝管不同程度的扩张,CT平扫可表现为低密度或稍低密度影以及等密度影,增强动脉期大多表现为不同程度强化,静脉期均呈轻度或中度不均匀性及网络样强化,延迟期为明显持续性强化;MRI平扫均为稍长T_(1)、等或稍长T_(2)信号,部分可见短T_(1)信号于扩张胆管内,增强显示部分病例强化形式类似于CT,于延迟期均表现为不均匀的较高信号。结论 CT和MRI检查均可对HCCA有显示,但MRI检查较CT检查可更为直观地显示肝脏及胆管情况,故在CT检查基础上联合MRI检查作为补充,可进一步提高HCCA患者术前诊断率,为手术提供更好的治疗条件。

Objective To investigate the diagnostic value of CT combined with magnetic resonance imaging(MRI)for hilar cholangiocarcinoma(HCCA).Methods 58 patients with HCCA treated in our hospital from December 2017 to December 2018 were selected as subjects.The results of surgical pathology were used as a standard to compare the diagnostic accordance rates of different examination methods for HCCA,and the image performance of HCCA in different imaging examinations was analyzed.Results The diagnostic coincidence rate of CT combined with MRI for HCCA(98.28%)was significantly higher than that of CT(62.07%)and MRI(82.76%).The diagnostic coincidence rate of MRI was significantly higher than that of CT(P<0.05).In CT and MRI,HCCA can be expressed as dilatation of the hepatic duct with different degrees.CT plain scan can be characterized by low-density or slightly low-density shadow and equal-density shadow.In the enhanced arterial phase,HCCA showed enhancement with different degrees,showed mild or moderate heterogeneity,and network-like enhancement in the venous phase,and showed significant sustained enhancement in the delayed phase.The MRI plain scan showed a slightly longer T_(1),equal or slightly longer T_(2) signal,and some of the short T_(1) signals were seen in the dilated bile duct.The enhancement showed that the enhanced form of some cases was similar to counterpart of CT,which showed a higher signal with unevenness in the delay period.Conclusion Both CT and MRI examinations can show HCCA,but MRI examination can show conditions of liver and bile duct more intuitively than CT examination.Therefore,CT examination combined with MRI examination can further improve the preoperative diagnostic rate for HCCA patients and provide better treatment conditions for surgery.