混合型肝癌超声造影与增强磁共振影像表现的对比分析

Comparative analysis of contrast-enhanced ultrasound and contrast-enhanced magnetic resonance imaging of mixed hepatocellular carcinoma

目的:分析比较混合型肝细胞癌-胆管癌(combined hepatocellular-cholangiocarcinoma, cHCC-ICC)的超声造影(contrast-enhanced ultrasound, CEUS)与增强磁共振成像(contrast-enhanced magnetic resonance imaging, CE-MRI)特点,并探究影像学联合肿瘤标志物检测对cHCC-ICC检出的提示作用,以期提高对cHCC-ICC的术前诊断水平。方法:回顾性分析并总结86例经病理证实为cHCC-ICC患者的术前CEUS及CE-MRI图像特征。探究“AFP和CA19-9同时升高”“CEUS/CE-MRI增强模式与肿瘤标志物升高不一致”“CEUS与CE-MRI增强模式不一致”及上述诊断标准联合对cHCC-ICC的诊断符合率。结果:cHCC-ICC在CEUS上病灶呈HCC和ICC增强模式的比例分别为36.0%及64.0%,在CE-MRI上这一比例分别为40.7%及59.3%。8.1%cHCC-ICC患者血清AFP与CA19-9水平同时升高,38.4%患者CEUS增强模式与肿瘤标志物升高不一致,41.9%患者CE-MRI增强模式与肿瘤标志物升高不一致,51.2%患者CEUS与CE-MRI增强模式存在差异,以上述标准对cHCC-ICC进行联合诊断,符合率为74.4%。结论:cHCC-ICC在CEUS及CE-MRI上可存在与HCC、ICC相似的影像学特点,以类ICC增强模式更多见。联合肿瘤标志物、CEUS及CE-MRI有助于提高对cHCC-ICC的检出率。

Objective: To investigate the imaging characteristics of combined hepatocellular-cholangiocarcinoma(cHCC-ICC) in contrast-enhanced ultrasound(CEUS) and contrast-enhanced magnetic resonance imaging(CE-MRI),and evaluate the diagnostic value of the combination of serum tumor marker,CEUS,and CE-MRI manifestation for cHCC-ICC. Methods: Retrospectively analyzed the CEUS and CE-MRI imaging characteristics of 86 patients with pathologically confirmed cHCC-ICC.Took "simultaneous elevation of AFP and CA19-9","discordance of enhancement pattern in CEUS or CE-MRI with elevated serum tumor marker","discordance of enhancement patterns in CEUS and CE-MRI" and the combination of the above criteria as the diagnostic criteria for cHCC-ICC,and calculated corresponding diagnostic ccuracies. Results: On CEUS,there were 36.0% and 64.0% of cHCC-ICC lesions showed an HCC-like pattern and ICC-like pattern,while the ratio on CE-MRI was 40.7% and 59.3%,respectively.No significant difference was found between the two imaging modalities.There were 8.1% of cHCC-ICC patients showed simultaneous elevation of serum AFP and CA19-9,38.4% of patients had inconsistent CEUS finding and elevated tumor markers,41.9% of patients had inconsistent CE-MRI presentation and elevated tumor markers,51.2% of nodules had discordance in CEUS and CE-MRI manifestation,and 74.4% of cHCC-ICC could be detected with the combination of diagnostic criteria mentioned above. Conclusion: cHCC-ICC shared overlapped imaging features with HCC and ICC.On CEUS and CE-MRI,cHCC-ICC tended to present as ICC-like pattern.The combination of serum tumor markers,CEUS,and CE-MRI help to make diagnosis of cHCC-ICC.