肝内胆管细胞癌与肝细胞癌病灶MRI增强扫描表现差异分析

Enhanced MRI manifestation feature in differential diagnosis of ICC and HCC:A single center study

目的分析总结肝内胆管细胞癌(ICC)与肝细胞癌(HCC)病灶增强磁共振成像(MRI)表现差异,为鉴别诊断提供依据。方法2019年12月~2023年7月我院诊治的原发性肝癌(PLC)患者120例,均接受MRI增强扫描,观察病灶强化特点,包括动脉期强化特征、动态强化模式、有无血流灌注异常、有无肝胆期靶征、病灶信号是否均匀、有无远端胆管扩张、有无包膜等特征。应用受试者工作特征曲线(ROC)下面积(AUC)分析MRI增强扫描特征鉴别诊断ICC与HCC的效能。结果在120例PLC患者中,经组织病理学检查诊断ICC者23例和HCC者97例;ICC病灶动脉期边缘强化、动态逐渐强化、肝胆期靶征和远端胆管扩张发生率分别为69.6%、56.5%、65.2%和39.1%,均显著高于HCC病灶的44.3%、17.5%、9.3%和3.1%,而病灶包膜发生率为4.3%,显著低于HCC病灶的45.4%(P<0.05);综合扫描特征,本组病例经MRI诊断ICC者31例,HCC者89例,其鉴别诊断ICC与HCC的敏感度为78.3%,特异度为86.6%,阳性预测值为58.1%,阴性预测值为94.4%。结论术前,可根据MRI增强扫描特征鉴别ICC与HCC提供帮助,为临床做出合理的处置方案提供依据。

Objective The purpose of this study was to summarize the enhanced magnetic resonance imaging(MRI)feature in differential diagnosis of intrahepatic cholangiocarcinoma(ICC)and hepatocellular carcinoma(HCC).Methods 120 patients with primary liver cancer(PLC)were encountered in our hospital between December 2019 and July 2023,and there all underwent enhanced MR scan before hepatectomy.The enhancement MR feature included arterial phase reinforcement characteristics,dynamic reinforcement patterns,abnormal blood perfusion,target sign at hepatobiliary phase,lesion signal form,distal bile duct dilation,and lesion capsule.The receiver operating characteristic curve(ROC)was applied to evaluate the differential diagnostic performance of MRI scanning.Results Out of the 120 patients with PLC,the histo-pathological examination diagnosed ICC in 23 cases and HCC in 97 cases;the percentages of edge of lesion enhancement at arterial phase,gradually dynamic enhancement mode,hepatobiliary target and distal bile duct dilatation in ICC lesions were 69.6%,56.5%,65.2%and 39.1%,all significantly higher than 44.3%,17.5%,9.3%and 3.1%,while the percentage of lesion envelope was 4.3%,much lower than 45.4%(P<0.05)in HCC lesions;based on comprehensive features,the MRI diagnosed ICC in 31 cases and HCC in 89 cases,with the sensitivity of 78.3%,the specificity of 86.6%,the positive predicting value of 58.1%and negative predicting value of 94.4%.Conclusion The enhanced MRI scanning could provide the clues for differentiating the ICC and HCC before surgery,which might help the clinicians make an appropriate management plans.