超声造影与增强CT对肝内胆管癌与肝细胞癌的鉴别价值

Contrast-enhanced ultrasonography and enhanced CT in differentiating intrahepatic cholangiocarcinoma from hepatocellular carcinoma

目的对比超声造影与增强CT鉴别胆管细胞癌(ICC)和肝细胞癌(HCC)的价值。方法回顾性分析南通肿瘤医院2020年1月至2022年1月收治的69例原发性肝癌的病历资料,以病理检测结果分为HCC 45例和ICC 24例。对比ICC、HCC在超声造影动脉期血流灌注参数水平:峰值强度(PI)、达峰时间(TTP)、达到时间(AT),以及增强CT动脉期(LAP)、门脉期(PVP)及平衡期(EP)CT值,评估超声造影与增强CT参数对ICC、HCC的鉴别诊断价值。结果ICC患者超声造影表现中肝内胆管扩张、动脉期环形强化、乏血供占比分别为70.83%(17/24)、62.50%(15/24)及70.83%(17/24),均高于HCC患者的40.00%(18/45)、20.00%(9/45)、40.00%(18/45)(P<0.05)。ICC患者增强CT表现中分叶征、肝内胆管扩张、动脉期环形强化占比分别为75.00%(18/24)、70.83%(17/24)及58.33%(14/24),均高于HCC患者的44.44%(20/45)、42.22%(19/45)、20.00%(9/45)(P<0.05)。ICC组TTP为(22.28±3.71)s,高于HCC组的(16.75±2.83)s(P<0.05)。ICC组EP期CT值为(98.65±8.74)Hu,高于HCC组的(87.05±7.24)Hu(P<0.05)。TTP对ICC的诊断效能高于EP(P<0.05)。超声造影与增强CT诊断ICC、HCC结果与病理结果一致性的Kappa值分别为0.596、0.470。结论超声造影与增强CT均可应用于ICC、HCC的临床诊断,且超声造影在ICC、HCC诊断中效能表现更为优越。

Objective To compare and analyze the value of contrast-enhanced ultrasound and enhanced CT in differentiating cholangiocarcinoma(ICC)and hepatocellular carcinoma(HCC).Methods The medical records of 69 patients diagnosed with primary liver cancer and admitted to Nantong cancer hospital from January 2020 to January 2022 were retrospectively analyzed.Patients were divided into two groups based on pathological examination:45 patients with HCC and 24 patients with ICC.All patients underwent contrast-enhanced ultrasound and enhanced CT.The study examined the manifestations of ICC and HCC using contrast-enhanced ultrasound and enhanced CT.Specifically,the researchers compared the blood perfusion parameters[peak intensity(PI),time to peak(TTP),time to arrival(at)]of ICC and HCC in arterial phase of contrast-enhanced ultrasound,as well as the CT values of arterial phase(LAP),portal phase(PVP)and equilibrium phase(EP)of contrast-enhanced CT.The aim was to evaluate the diagnostic value of contrast-enhanced ultrasound and enhanced CT parameters in distinguishing HCC.Results In patients with ICC,the ultrasound contrast imaging showed that the percentages of intrahepatic bile duct dilatation,arterial phase ring enhancement,and hypovascular were 70.83%,62.50%,and 70.83%,respectively,all of which were higher than those in HCC patients(40.00%,20.00%,40.00%,P<0.05).Similarly,the enhanced CT findings in ICC patients showed that the percentages of segmental signs,intrahepatic bile duct dilatation,and arterial phase ring enhancement were 75.00%,70.83%,and 58.33%,respectively,all of which were higher than those in HCC patients(44.44%,42.22%,20.00%,P<0.05).The TTP in the ICC group was(22.28±3.71)s,which was higher than that in the HCC group[(16.75±2.83)s,P<0.05].The EP phase CT value in the ICC group was(98.65±8.74)Hu,which was higher than that in the HCC group[(87.05±7.24)Hu,P<0.05].TTP had a higher diagnostic efficacy for ICC than EP(P<0.05).The kappa values for the consistency of ultrasound contrast imaging and enhanced CT with pathological results in diagnosing ICC and HCC were 0.596 and 0.470,respectively.Conclusion Both contrast-enhanced ultrasound and enhanced CT can be utilized for the clinical diagnosis of ICC and HCC.However,contrast-enhanced ultrasound proves to be more effective in the diagnosis of ICC and HCC.