术前CT血管造影不同后处理方法对肝门部胆管细胞癌血管侵犯的诊断价值

目的:探讨术前256层螺旋CT血管造影（256-slice spiral CT angiography,256-SCTA）常用后处理方法在肝门部胆管细胞癌肝动脉、门静脉侵犯评估中的诊断价值。方法:回顾性纳入2015年3月至2017年8月西安交通大学第一附属医院35例经病理证实的肝门部胆管细胞癌患者，所有患者术前均行256层螺旋CT血管造影检查，并采用动态容积扫描及Philip EBW后处理工作站对肝动脉及门静脉行容积再现（volume rendering,VR）、最大密度投影（maximum intensity projection,MIP）及多平面重组（multi-planar-reformatting,MPR）重建，在相应后处理图像中评估肿瘤周围血管有无受侵，以术中探查结果作为金标准，分别计算三种后处理方法的灵敏度、特异度、准确率并行Kappa检验以比较三种后处理方法的诊断效能。结果:判断肝动脉有无受侵时，诊断效能以MPR最佳，其诊断灵敏度、特异度、准确性分别为92.3%、86.4%、88.6%，阳性预测值80.0%，阴性预测值95.0%，Kappa值0.763（P＜0.001），ROC曲线下面积0.893（P＜0.01）。判断门静脉有无受侵时，诊断效能同样以MPR最佳，其诊断灵敏度、特异度、准确性分别为94.4%、100.0%、97.1%，阳性预测值100%，阴性预测值94.4%，Kappa值0.943（P＜0.001），ROC曲线下面积0.972（P＜0.01）。结论:256-SCTA三种常用后处理方法在判断肝门部胆管细胞癌血管有无受侵时以MPR诊断效能最高，VR及MIP次之。因此，在日常影像后处理工作中应合理应用这些后处理方法以便为临床术前血管评估提供更准确的信息。

Value of different reconstruction methods of preoperative CT angiography in the diagnostic of blood vessel invasion of hilar cholangiocarcinoma

Objective:To investigate the value of different reconstruction methods of perioperative 256-slice spiral CT angiography in the diagnostic of hepatic artery and portal vein invasion in hilar cholangiocarcinoma.Methods:From March 2015 to August 2017,a total of 35 consecutive patients were included.All patients underwent preoperative CTA and surgical treatment,and were pathologically proven with hilar cholangiocarcinoma.The CTA images were reviewed retrospectively by two attending radiologists.The hepatic artery and portal vein were demonstrated and evaluated by volume rendering (VR),maximum intensity projection (MIP) and multi-planar-reformatting (MPR) respectively on Philip EBW post-processing workstation to decide whether they were invaded.The surgical findings were considered to be the gold standard.The sensitivity,specificity and accuracy of the three reconstruction methods were calculated respectively.In addition,Kappa test was employed to compare the diagnostic efficiency of the three reconstruction methods.Results:MPR was the best method for hepatic artery invasion assessment,the sensitivity,specificity,accuracy,positive predictive value,negative predictive value were 92.3%,86.4%,88.6%,80.0%,95.0%,respectively.Kappa value was 0.763（P＜0.001）.Receiver operator characteristic (ROC) analysis revealed an area under the curve (AUC) of 0.893（P＜0.01）.MPR was also the optimal method for portal vein invasion assessment,the sensitivity,specificity,accuracy,positive predictive value,negative predictive value were 94.4%,100.0%,97.1%,100%,94.4%,respectively.Kappa value was 0.943（P＜0.001）.Receiver operator characteristic (ROC) analysis revealed an area under the curve (AUC) of 0.972（P＜0.01）.Conclusion:Among VR,MIP,MPR,MPR shows the optimal diagnostic efficiency in the assessment of blood vessel invasion of hilar cholangiocarcinoma.Followed by VR and MIP.Hence,these reconstruction methods should be used reasonably on daily image post processing work to provide more accurate information for clinical preoperative blood vessel assessment.