应用多模态MRI鉴别诊断肿块型肝内胆管细胞癌和不典型肝脓肿

Application of multimodal MRI to differential diagnosis of intrahepatic mass-type cholangiocarcinoma from atypical liver abscess

目的探讨多模态磁共振成像(MRI)鉴别诊断肿块型肝内胆管细胞癌(IMCC)与不典型肝脓肿(AHA)的应用价值。方法回顾性分析2021年1月至2024年4月咸阳市中心医院23例IMCC(IMCC组)和26例AHA(AHA组)患者的临床资料及MRI图像,观察两组病灶MRI平扫、动态增强、扩散加权图像特征以及病灶周围伴随征象,分别测量病灶边缘实性部分及内部非囊变坏死部分的平均表观扩散系数(ADCmean)值及相对表观扩散系数(rADC)值。比较两组患者病灶MRI征象及ADC值的差异。结果IMCC多位于肝左叶(13/23),MRI增强多表现为花环状渐进性强化或片絮状不均匀强化;AHA多位于肝右叶(19/26),MRI增强多表现为环簇状持续性强化。IMCC患者与AHA患者MRI影像学特征中,环簇状持续性强化[8.70%(2/23)vs 57.69%(15/26)]、片絮状不均匀强化[34.78%(8/23)vs 7.69%(2/26)]、“强化环中断征”[43.48%(10/23)vs 11.54%(3/26)]在两组间差异具有统计学意义(P<0.05);病灶边缘ADCmean值[0.71(0.66,0.81)×10^(-3)mm^(2)/s vs 1.41(1.33,1.47)×10^(-3)mm^(2)/s]和rADC值[0.82(0.78,0.91)vs 1.33(1.28,1.50)]在两组间差异具有统计学意义(P<0.05);病灶内部ADCmean值[1.15(1.04,1.29)×10^(-3)mm^(2)/s vs 1.25(1.08,1.57)×10^(-3)mm^(2)/s]和rADC值[(1.26±0.24)vs(1.29±0.30)]在两组间差异无统计学意义(P>0.05);肝包膜凹陷、肝内胆管扩张、周围血管侵犯比例在两组间差异均具有统计学意义(P<0.05)。结论多模态MRI有助于鉴别IMCC与AHA,具有一定的临床应用价值。

Objective To investigate the application value of multimodal magnetic resonance imaging(MRI)to differential diagnosis of intrahepatic mass-forming cholangiocarcinoma(IMCC)from atypical hepatic abscess(AHA).Methods The clinical data and MRI images of 23 patients with IMCC(the IMCC group)and 26 patients with AHA(the AHA group)admitted to Central Hospital of Xianyang between Jan.2021 and Apr.2024.The MRI scanning,dynamic enhancement,and diffusion-weighted image features as well as the concomitant signs around the lesions were observed between the two groups.Additionally,the average apparent diffusion coefficient(ADCmean)values and relative apparent diffusion coefficient(rADC)values were measured for the solid portion of the edge of the lesion,and the non-cystic necrotic portion of the inner portion of the lesion,respectively.The differences in MRI signs and ADC values between the two groups of lesions were compared.Results IMCC was predominantly located in the left lobe of the liver(13/23),its enhancement pattern was characterized by wreath-like progressive enhancement or flocculent inhomogeneous enhancement.In contrast,AHA was mostly located in the right lobe of the liver(19/26),exhibiting a pattern of ring-cluster persistent enhancement.Patients between IMCC and AHA in MRI imaging characteristics,there were stastistically signifaciant defference in the ring-cluster persistent enhancement[8.70%(2/23)vs 57.69%(15/26)],flocculent inhomogeneous enhancement[34.78%(8/23)vs 7.69%(2/26)],and enhancement ring interruption sign[43.48%(10/23)vs 11.54%(3/26)],with all P<0.05.The ADCmean value[0.71(0.66,0.81)×10^(-3)mm^(2)/s vs 1.41(1.33,1.47)×10^(-3)mm^(2)/s]and the rADC value[0.82(0.78,0.91)vs 1.33(1.28,1.50)]at the edge of the lesion were also statistically different between patients with IMCC and AHA(P<0.05).However,there was no statistically significant difference in the ADCmean value of diffusion-restricted features within the lesion[1.15(1.04,1.29)×10^(-3)mm^(2)/s vs 1.25(1.08,1.57)×10^(-3)mm^(2)/s]and the rADC value[(1.26±0.24)vs(1.29±0.30)]between the two groups(P>0.05).Hepatic pericardial depression,intrahepatic bile duct dilatation,and peripheral vascular invasion exhibited statistically significant differences between the two groups(P<0.05).Conclusion Multimodal MRI may help to differentiate IMCC from AHA,which has certain clinical application value.