钆塞酸二钠增强MRI对不典型肝细胞癌和肝内胆管细胞癌的鉴别诊断价值

目的 探讨钆塞酸二钠（Gd-EOB-DTPA） 增强 MRI对最大径≤3 cm的不典型肝细胞癌（HCC）及肝内胆管细胞癌（ICC）的鉴别诊断价值。 方法 回顾性纳入经病理证实的最大径≤3 cm的不典型HCC 26例[男17例,女9例,平均年龄（56.9±11.3）岁;HCC组]及ICC 21例[男16例,女5例,平均年龄（58.2±11.6）岁;ICC组]的临床及影像资料。评估2种肿瘤平扫及Gd-EOB-DTPA动态增强MRI上影像特征,包括肿瘤最大径、病灶边缘、病灶包膜、伴远端胆管扩张情况、病灶信号是否均匀、瘤体ADC值、动脉期强化特征、瘤周血流灌注是否异常、动态强化方式及肝胆期信号特征。采用t检验及χ ²检验分析2组的临床特征和常规平扫序列、增强MRI表现的差异,采用多因素Logistic回归分析鉴别两者的预测因素。2名影像医师对2种肿瘤的平扫及增强影像诊断结果的一致性分析采用kappa检验。 结果 HCC组病人相比ICC组多有肝炎及肝硬化病史,血清肿瘤标志物甲胎蛋白（AFP）高于ICC组,而ICC组的糖类抗原199（CA-199）水平更高;常规平扫序列MRI上HCC组病灶常有包膜,而ICC组常伴远端胆管扩张且ADC值更高;增强后ICC组更多表现为动脉期边缘强化、中央逐渐强化,更易出现肝胆期靶征改变（均P<0.05）。多因素Logistic回归分析显示增强动脉期边缘强化及肝胆期靶征为鉴别诊断HCC和ICC的重要预测征象。2名影像医师诊断一致性良好（κ=0.837,P<0.001)。 结论 Gd-EOB-DTPA 增强MRI肝胆期靶征和动脉期边缘强化对最大径≤3 cm的不典型HCC及ICC有重要鉴别诊断价值,可为治疗方案提供参考。

The value of Gd-EOB-DTPA enhanced MRI in the differential diagnosis of atypical hepatocellular carcinoma and intrahepatic cholangiocarcinoma

Objective To explore the value of Gd-EOB-DTPA enhanced MRI in the differential diagnosis of atypical hepatocellular carcinoma and intrahepatic cholangiocarcinoma with maximum diameter≤3 cm.Methods Clinical and imaging data of 26 patients of atypical hepatocellular carcinoma(17 males,9 females,average age 56.9±11.3 years)and21 patients of intrahepatic cholangiocarcinoma(16 males,5 females,average age 58.2±11.6 year)with maximum diameter≤3 cm were retrospectively included..The imaging features of these two tumors on plain scan and Gd-EOB-DTPA enhanced MRI were evaluated,including the maximum diameter,edge,capsule,the dilatation of distal bile duct,signal,apparent diffusion coefficient(ADC)of tumor,the enhancement characteristics in arterial phase,the abnormal blood perfusion around tumor,and the dynamic enhancement mode and the signal characteristics in hepatobiliary phase.The t test andχ~2 test were used to analyze the difference in the clinical features,and imaging manifestations on the plain scan and Gd-EOB-DTPA enhanced MRI between the two groups.The multivariate logistic regression analysis was then performed to identify the predictors of two kinds of tumors.Kappa test was used to analyze the consistency of the plain and enhanced imaging diagnostic results by two radiologists.Results Compared with intrahepatic cholangiocarcinoma,patients of hepatocellular carcinoma had more history of hepatitis and liver cirrhosis,serum tumor marker AFP was higher,and the level of CA-199 in intrahepatic cholangiocarcinoma was higher.On plain scan MRI,the hepatocellular carcinoma often had capsule,while the intrahepatic cholangiocarcinoma often resulted in distal bile duct dilatation and higher ADC value.After Gd-EOB-DTPA enhanced MRI,most of the intrahepatic cholangiocarcinoma had peripheral enhancement in arterial phase and then central gradual enhancement,and were more likely to have target signs in hepatobiliary phase(all P<0.05).Multivariate logistic regression analysis showed the edge enhancement in arterial phase and target sign in hepatobiliary phase,which were important predictive signs for the differential diagnosis of hepatocellular carcinoma and intrahepatic cholangiocarcinoma.The two radiologists had good consistency in the diagnosis(κ=0.837,P<0.001).Conclusion Intratumoral target sign in hepatobiliary phase and edge enhancement in arterial phase have great value in differentiating atypical hepatocellular carcinoma from intrahepatic cholangiocarcinoma with maximum diameter≤3 cm,which can provide references for treatment planning.