双源CT和功能磁共振成像对肝内胆管细胞癌术前精准T分期的评价

目的探讨双源CT(dual source CT,DSCT)和功能磁共振成像(fMRI)对肝内胆管细胞癌(ICC)术前精准T分期诊断的准确性及其临床应用价值。方法选取2017年1月~2019年12月间在本院进行手术切除治疗的肝内胆管细胞癌患者,所有患者均在术前两周内行DSCT和fMRI扫描检查。以术后病理分期结果为金标准,检查结果与病理相关性行一致性检验,运用卡方检验对比联合检查和单独检查诊断术前ICC分期的准确率、灵敏度、特异度。结果纳入110例患者,其中,男性64例,女性46例,平均年龄(61.2±10.5)岁。联合检查诊断术前肝内胆管细胞癌患者T分期的准确率为95.45%,与单独行fMRI检查的准确率(92.73%)相比差异无统计学意义,但明显高于单独行DSCT检查的准确率(80.00%)。联合检查和单独行fMRI检查诊断T分期结果与病理的一致性较强(Kappa值为0.928和0.886),优于单独行DSCT检查与病理的一致性(Kappa值为0.692)。在诊断效能方面,联合检查诊断T1和T2期的灵敏度优于单独行DSCT检查,特异度无明显差异。而单独行fMRI检查诊断T分期的效能与联合检查相比差异不大。结论联合应用双源CT(DSCT)和fMRI在一定程度上能提高肝内胆管细胞癌术前T分期的准确性,与病理结果的一致性更强,但与单独行fMRI检查诊断分期的结果相比诊断效能提升不显著。

Evaluation of dual source CT and functional magnetic resonance imaging in accurate preoperative T staging of intrahepatic cholangiocarcinoma

Objective To investigate the accuracy and clinical application value of dual source CT(DSCT)and functional magnetic resonance imaging in the diagnosis of accurate preoperative T staging of intrahepatic cholangiocarcinoma(ICC).Methods Patients who had surgical resection for intrahepatic cholangiocarcinoma in our hospital from January 2017 to December 2019 were retrospectively enrolled.All patients underwent DSCT and fMRI scan within two weeks before operation.The results of postoperative pathological staging were taken as the gold standard.The consistency test was performed between test results and pathology,and chi-square test was used to compare the accuracy,sensitivity and specificity of combined and individual examination.Results A total of 110 patients were enrolled in the study,including 64 males and 46 females,with an average age of(61.2±10.5)years.The accuracy of T staging in patients with intrahepatic cholangiocarcinoma diagnosed by combined examination was 95.45%,which was not statistically different from that of fMRI alone(92.73%),but higher than that of DSCT alone(80.00%).The results of T staging diagnosed by combined examination and fMRI alone indicated good consistency with pathology(Kappa values were 0.928 and 0.886),which were better than that of DSCT alone(Kappa value was 0.692).In terms of diagnostic efficacy,the sensitivity of combined examination for diagnosis of T1 and T2 staging was better than that of DSCT alone,but there was no significant difference in specificity.The efficacy of fMRI alone for diagnosis of T staging was not much different from that of combined examination.Conclusion Combined application of dual source CT(DSCT)and fMRI can improve the accuracy of preoperative T staging of intrahepatic cholangiocarcinoma to some extent,and indicate higher consistency with pathology.However,the diagnostic efficiency is not significantly better than that of fMRI alone.