多模态影像技术在肝囊型包虫病分型中的应用价值

Application Value of Multimodal Imaging Technique in the Classification of Hepatic Cystic Echinococcosis

目的探讨超声、CT、MRI在肝囊型包虫病分型中的应用价值。方法分析我院同时用超声、CT、MRI检查经手术病理证实的肝囊型包虫病患者50例81个病灶,计算敏感度、特异度并比较其差异性。结果以WHO分型为标椎,50例患者中,超声、CT分别检出CE1型21例、CE2型16例、CE3型19例、CE4型16例、CE5型9例,MRI检出CE1型15例、CE2型18例、CE3型27例、CE4型15例、CE5型6例。超声和CT的敏感度、特异度一致,CE1-CE5分别为:100%90%、88%100%、70%100%、100%100%、100%100%;MRI对CE1-CE4型的敏感度、特异度为100%,对CE5型敏感度、特异度为6.6%100%.;两者之间比较,差异无统计学意义(χ;=3141,P>005)。其中,9例病灶合并胆管扩张并胆瘘形成,8例病灶内含有点状类圆形的脂滴成分,3例患者合并内外囊直接性破裂。结论通过比较各型的敏感度、特异度,CT、MRI对肝囊型包虫各型病灶的特征性征象显示上更加清晰,以及MRI对分型诊断更加准确,对胆管扩张及胆瘘形成上,有其特有的优势。

Objective To explore the value of ultrasound, CT and MRI in the classification of hepatic cystic echinococcosis(HCE). Methods A total of 50 HCE patients with 81 hydatids confirmed by surgery and pathology were envolved in hospital. The sensitivity and specificity of the three methods in diagnosing various types of lesions were calculated. The differences among the types were compared by means of chi-square. Results Among them,according to the WHO classification, 21 lesions of CE1 type, 16 lesions of CE2 type, 19 lesions of CE3 type, 16 lesions of CE4 type and 9 lesions of CE5 type were were detected by CT and ultrasound, respectively and 15 lesions of CE1, 18 lesions of CE2, 27 lesions of CE3, 15 lesions of CE4 and 6 lesions of CE5 were detected by MRI.The sensitivity and specificity of ultrasound and CT were as follows: 100% 90%, 88% 100%, 70% 100%, 100% 100%, 100% 100%. The sensitivity and specificity of MRI to CE1-CE4 were 100%, and CE5 were 66% 100%.There was no statistical difference between the CT, MRI(χ~2=3.141, P>0.05). Among them, 9 cases were associated with cholangiectasis and biliary fistula formation, 8 cases contained punctured round lipid droplets, and 3 cases were associated with direct rupture of internal and external capsules. Conclusion By comparing the sensitivity and specificity of each type, CT and MRI showed more clearly the characteristic signs of each type of hydatid of liver capsule, and MRI was more accurate in the diagnosis of types, with its unique advantages in the dilation of bile duct and the formation of biliary fistula.