CT对肝局灶性慢性炎症病变与肝内肿块型胆管细胞癌的鉴别诊断

CT Features in the Differential Diagnosis Between Focal Chronic Inflammatory Hepatic Lesions and Intrahepatic Cholangiocarcinoma

目的 探讨CT特征对肝局灶性慢性炎症病变(FCIHL)与肝内肿块型胆管细胞癌的鉴别诊断价值。资料与方法 回顾性收集2015年6月—2022年6月遂宁市中心医院经病理证实的17例FCIHL、22例肝内肿块型胆管细胞癌的影像学资料,所有患者均行上腹部CT平扫+增强。比较两组病灶大小、形态、边缘、密度均匀性、强化模式、伴随征象及增强扫描各期病灶实质部位/正常肝实质CT值比率,并使用受试者工作特征曲线比较各特征对两者的鉴别效能。结果 两组病灶大小、形态、边缘、密度均匀性及强化模式比较,差异无统计学意义(χ~2=1.982~0.834,P均>0.05)。在伴随征象方面,两组远端胆管扩张及病灶周围异常灌注发生率差异无统计学意义(χ~2=2.464,P均>0.05);FCIHL组不易发生血管侵犯(1/17,5.9%),与肝内肿块型胆管细胞癌(13/22,59.0%)对比,差异有统计学意义(P<0.05)。平衡期,两组病灶实质部位/正常肝实质CT值比率差异有统计学意义(t=11.18,P<0.05)。平衡期病灶实质部位/正常肝实质CT值比率(曲线下面积为0.995)鉴别诊断FCIHL及肝内肿块型胆管细胞癌效能显著高于血管侵犯(曲线下面积为0.766;Z=3.657,P<0.01)。结论 平衡期病灶实质部位/正常肝实质CT值比率、血管侵犯鉴别FCIHL及肝内肿块型胆管细胞癌有一定参考价值,前者的鉴别效能较高。

Purpose To explore the differential diagnosis value of CT features between focal chronic inflammatory hepatic lesions(FCIHL)and intrahepatic cholangiocarcinoma.Materials and Methods A total of 17 patients with FCIHL,22 patients with intrahepatic cholangiocarcinoma confirmed by pathology were retrospectively analyzed from June 2015 to June 2022 in Suining Central Hospital.All patients were performed plain CT and enhanced CT on upper abdomen.The lesion size,shape,margin,density,enhancement pattern,concomitant signs,and ratio of CT intensity in every enhanced scanning phases were compared between two groups,and the receiver operating characteristic curve was used to compare the distinguishing effect ofeach feature,respectively.Results There were no significant differences in CT features in morphology,edge,density uniformity,size and enhancement pattern between FCIHL and intrahepatic cholangiocarcinoma groups(χ2=-1.982-0.834,all P>0.05),and there were no significant differences in incidence of distal bile duct expansion and abnormal perifocal perfusion between the two groups(χ2=2.464,P>0.05).FCIHL was rarely accompanied by vascular invasion,and there were significant difference in vascular invasion between FCIHL andintrahepatic cholangiocarcinoma groups(1/17,5.9%vs.13/22,59.0%,P<0.05).There was statistically significant difference in ratio of CT intensity on delay phase between two groups(t=11.18,P<0.05).The area under the curve of CT intensity ratio on delay phase(0.995)was significantly higher than that of vascular invasion(0.766)in differentiating FCIHL from intrahepatic cholangiocarcinoma(Z=3.657,P<0.01).Conclusion CT intensity ratio on delay phase and vascular invasion have diagnostic value to some extent for distinguishing FCIHL from intrahepatic cholangiocarcinoma,and the former have higher discriminative efficiency.