钆塞酸二钠增强MRI联合肿瘤标志物鉴别诊断混合型肝细胞癌-胆管癌与肝内肿块型胆管癌

Gd-EOB-DTPA enhanced MRI combining with tumor markers for differential diagnosis of combined hepatocellular-cholangiocarcinoma and intrahepatic mass-forming cholangiocarcinoma

目的观察钆塞酸二钠(Gd-EOB-DTPA)增强MRI联合肿瘤标志物鉴别诊断混合型肝细胞癌-胆管癌(cHCC-CCA)与肝内肿块型胆管癌(IMCC)的价值。方法回顾性分析经病理证实的33例cHCC-CCA(cHCC-CCA组)及58例IMCC(IMCC组)的临床及腹部平扫MRI、弥散加权成像(DWI)和Gd-EOB-DTPA增强MRI资料,对比观察2组所见;采用单因素和多因素logistic回归筛选鉴别cHCC-CCA与IMCC的独立影响因素,绘制受试者工作特征(ROC)曲线,计算曲线下面积(AUC),评价各独立影响因素单独及联合诊断cHCC-CCA的效能。结果单因素logistic回归分析显示,甲胎蛋白(AFP)升高、糖类抗原19-9(CA19-9)升高及MRI所示肿瘤出血、肝包膜回缩征、延迟强化、马赛克征、包膜征、肝胆特异期(HBP)靶征和DWI所见靶征是cHCC-CCA与IMCC的影响因素(P均<0.05)。多因素logistic回归分析显示,AFP升高(OR=8.003)、MRI显示HBP靶征(OR=0.033)及DWI所见靶征(OR=0.239)是鉴别cHCC-CCA与IMCC的独立影响因素(P均<0.05),其诊断cHCC-CCA的AUC分别为0.654、0.743及0.719,均低于三者联合(0.885,P均<0.01)。结论Gd-EOB-DTPA增强MRI联合肿瘤标志物可有效鉴别诊断cHCC-CCA与IMCC。

Objective To investigate the value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)enhanced MRI combining with tumor markers for differential diagnosis of combined hepatocellular-cholangiocarcinoma(cHCC-CCA)and intrahepatic mass-forming cholangiocarcinoma(IMCC).Methods Clinical and abdominal plain MRI,diffusion weighted imaging(DWI)and Gd-EOB-DTPA enhanced MRI data of 33 patients with cHCC-CCA(cHCC-CCA group)and 58 patients with IMCC(IMCC group)confirmed pathologically were retrospectively analyzed.The general clinical indicators and MRI findings of both groups were analyzed,and univariate and multivariate logistic regression analysis were used to screen out the independent impact factors for differentiating cHCC-CCA and IMCC.Then receiver operating characteristic(ROC)curves were drawn,and the area under the curve(AUC)was calculated to evaluate the value of each independent impact factor alone and their combination for diagnosing cHCC-CCA.Results Univariate logistic regression analysis showed that increased alpha fetoprotein(AFP),increased carbohydrate antigen 19-9(CA19-9)and tumor hemorrhage,liver capsule retraction sign,delayed enhancement,mosaic sign,capsule sign,hepatobiliary phase(HBP)target sign on MRI and target sign shown on DWI were all impact factors for differentiating cHCC-CCA and IMCC(all P<0.05).Multivariate logistic regression analysis showed that increased AFP(OR=8.003),HBP target sign(OR=0.033)and target sign on DWI(OR=0.239)were independent impact factors for differentiating cHCC-CCA and IMCC(all P<0.05).The AUC of increased AFP,HBP target sign and target sign on DWI for diagnosing cHCC-CCA was 0.654,0.743 and 0.719,respectively,all lower than that of the combination of the above three(0.885,all P<0.01).Conclusion Gd-EOB-DTPA enhanced MRI combining with tumor markers could be used to effectively differentiate cHCC-CCA and IMCC.