MSCT与MRI动态增强扫描对高血供肝内胆管癌与肝细胞癌的诊断价值分析

目的 探讨多层螺旋计算机断层扫描(MSCT)与磁共振成像(MRI)动态增强扫描对高血供肝内胆管癌(ICC)和肝细胞癌(HCC)的诊断价值。方法 2018年1月～2019年6月我科诊治的70例原发性肝癌患者,均接受MSCT和MRI动态增强扫描。以手术后组织病理学检查诊断作为金标准,评估两种检查方法的诊断效能。结果 经手术后组织病理学检查,在70例原发性肝癌患者中,诊断ICC 12例,HCC 58例;MSCT检查显示HCC病灶动脉期强化、静脉期强化减退,延迟期持续强化减退;MRI多期扫描检查显示39例HCC患者病灶呈快进快出型强化,17例患者病灶呈快进慢出型强化,2例患者病灶呈慢进慢出型强化。MRI多期扫描发现9例ICC患者病灶呈慢进慢出型,3例患者病灶在动脉期和门脉期未出现明显强化,延迟期逐渐呈均匀性强化;MRI诊断HCC患者56例(96.6%),与CT诊断的53例(91.4%)比,无显著性差异(P>0.05),而诊断ICC患者9例(75.0%),显著高于CT诊断的7例(58.3%,P<0.05)。结论 在富血供的PLC患者,ICC和HCC的影像学表现有所差异,应用MRI增强扫描有利于提高对ICC的诊断检出率,值得临床积累经验和应用。

Clinicalvalue of MSCT and MRI dynamic enhanced scans in diagnosing patients with intrahepatic cholangiocarcinoma and hepatocellular carcinoma with high blood supply

Objective The aim of this study was to investigate the clinical application of MSCT and MRI dynamic enhanced scans in diagnosing patients with intrahepatic cholangiocarcinoma (ICC) and hepatocellular carcinoma (HCC) with high blood supply. Methods A total of 70 patients with primary liver cancer were admitted to our hospital between January 2018 and June 2019, and all underwent MSCT and MRI dynamic enhanced scans. The post-operational histopathological examination was performed as a gold diagnostic criterion. Results The post-operational histopathological examination showed 12 patients with ICC, and 58 patients with HCC in our series; the MSCT multi-phase enhancement demonstrated arterial phase enhancement, venous phase enhancement decline and even enhancement decline in delayed phase in 53 patients with HCC, and arterial phase enhancement, continuous portal phase and delayed phase enhancement in 7 lesions in 12 patients with ICC; the MRI multi-phase enhancement found in 58 patients with HCC having 39 lesions of fast-in and fast-out type enhancement, having 17 lesions of fast-in and slow-out, and having 2 lesions of slow-in and slow-out, and in 12 patients with ICC having 9 lesions of slow-in and slow-out type and having 3 lesions without significant enhancement in arterial and portal phases and with gradually enhancement in delayed phase; the MRI scan made a correct diagnosis of HCC in 56 patients (96.6%), not significantly different compared to in 53 cases (91.4%) by MSCT scan (P>0.05), while it found ICC in 9 patients (75.0%) with ICC, significantly higher than in 7 patients (58.3%) by CT scan (P<0.05). Conclusion There are imaging differences in patients with ICC and HCC with rich blood supply, and the MRI scan might improve diagnosing patients with ICC earlier, which warrants further clinical investigation.