钆塞酸二钠增强MRI对混合型肝细胞癌-胆管癌与肝细胞癌的鉴别诊断价值

Value of Gd-EOB-DTPA Enhanced MRI in the Differential Diagnosis of Combined Hepatocellular Cholangiocarcinoma and Hepatocellular Carcinoma

目的探讨钆塞酸二钠(Gd-EOB-DTPA)增强MRI对混合型肝细胞癌-胆管癌(cHCC-CCA)与肝细胞癌(HCC)的鉴别诊断价值。方法回顾性纳入2019年2月至2022年9月郑州市第九人民医院和河南中医药大学第一附属医院经病理证实的51例cHCC-CCA和82例HCC患者。所有患者均行MRI平扫、扩散加权成像(DWI)及Gd-EOB-DTPA增强检查,比较两组患者的临床资料和MRI征象。使用logistic回归分析筛选出鉴别cHCC-CCA与HCC的独立预测指标,采用受试者工作特征(ROC)曲线分析各独立因素及其联合模型预测cHCC-CCA的诊断效能。结果单因素logistic回归分析结果显示,糖类抗原19-9(CA19-9)升高(25/51)、动脉期环形强化(23/51)、门脉期周边廓清(14/51)、延迟性中央强化(16/51)、马赛克征(28/51)及DWI/肝胆期(HBP)靶征(29/51)提示为cHCC-CCA;而肿瘤出血(32/82)、“快进快出”(63/82)提示为HCC(P<0.05)。多因素logistic回归分析显示,CA19-9升高、动脉期环形强化及DWI/HBP靶征是鉴别cHCC-CCA与HCC的独立预测指标(P<0.05)。CA19-9升高、动脉期环形强化、DWI/HBP靶征独立及三者联合模型诊断cHCC-CCA的曲线下面积(AUC)分别为0.702、0.671、0.748及0.870,联合模型可提高诊断效能(P<0.05)。结论Gd-EOB-DTPA增强MRI对cHCC-CCA与HCC的鉴别诊断具有重要价值,CA19-9升高、动脉期环形强化及DWI/HBP靶征是cHCC-CCA的独立预测指标,结合3个独立指标的联合模型可提高诊断效能。

Objective To investigate the differential diagnostic value of gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)enhanced MRI for combined hepatocellular-cholangiocarcinoma(cHCC-CCA)and hepatocellular carcinoma(HCC).Methods The clinical data and MRI features of 51 cHCC-CCA and 82 HCC patients confirmed by pathology were collected from February 2019 to September 2022 in Zhengzhou Ninth People’s Hospital and the First Affiliated Hospital of Henan University of Traditional Chinese Medicine,and all patients underwent plain and Gd-EOB-DTPA-enhanced MRI and diffusion-weighted imaging(DWI).The clinical data and MRI signs of the two groups were compared.Logistic regression analysis was used to screen the independent predictors to distinguish cHCC-CCA from HCC.The receiver operating characteristic(ROC)curve was used to analyze the diagnostic efficacy of each independent indicator and its combined predition model in the diagnosis of cHCC-CCA.Results Univariate logistic regression analysis showed that elevated carbohydrate antigen 19-9(CA19-9)(25/51),rim arterial phase hyperenhancement(23/51),peripheral washout in portal venous phase(14/51),delayed central enhancement(16/51),mosaic sign(28/51)and DWI/hepatobiliary phase(HBP)targetoid sign(29/51)were suggested cHCC-CCA,whereas tumor hemorrhage(32/82)and wash-in and wash-out enhancement pattern(63/82)were suggested HCC(P<0.05).Multivariate logistic regression analysis showed that elevated CA19-9,rim arterial phase hyperenhancement and DWI/HBP targetoid sign were independent predictors in differentiating cHCC-CCA from HCC(P<0.05).The area under the curve(AUC)for elevated CA19-9,rim arterial phase hyperenhancement,targetoid sign and its combined predition model in the diagnosis cHCC-CCA were 0.702,0.671,0.748 and 0.870,respectively.The diagnostic efficacy of the combination of three indicators was improved(P<0.05).Conclusion Gd-EOB-DTPA enhanced MRI is of great value in the differential diagnosis of cHCC-CCA and HCC,and elevated CA19-9,rim arterial phase hyperenhancement and DWI/HBP targetoid sign are independent predictors of cHCC-CCA,and the combined predition model can improve the diagnostic efficacy.