CT、MRI技术在肝内胆管癌诊断中的联合应用价值(1)
[摘要]目的 探讨CT、MRI技术在肝内胆管癌诊断中的联合应用价值。方法 选取我院肝胆胰肿瘤外科2014年3月～2016年3月收治的30例肝内胆管癌患者作为研究对象，分别行CT平扫及增强扫描、MRI检查。统计CT、MRI及联合诊断的敏感度、特异度、准确度。结果 经病理诊断，30例患者中确诊26例胆管癌，4例为非膽管癌。CT的敏感度为100.0%，特异度为50.0%，准确度为86.7%；MRI检查的敏感度为100.0%，特异度为100.0%，准确度为100.0%。联合检测的诊断准确度为100.0%，高于CT检测的86.7%，差异有统计学意义(P<0.05)。结论 对肝内胆管癌患者采用CT联合MRI技术进行诊断，准确率高，能够迅速对患者的病灶发展情况有准确的了解，具有较高的诊断价值，值得临床推广应用。
[关键词]CT；MRI；肝内胆管癌；诊断
[中图分类号] R445.2 [文献标识码] A [文章编号] 1674-4721(2017)04(c)-0122-03
[Abstract]Objective To explore the combined application value of CT and MRI in the diagnosis of intrahepatic cholangiocarcinoma.Methods 30 patients with intrahepatic cholangiocarcinoma in our hospital from March 2014 to March 2016 were selected as the research object，CT plain scan and enhanced scan，MRI examination was given respectively.The sensitivity，specificity and accuracy of CT，MRI and combined diagnosis were statistically analyzed.Results In pathological diagnosis，30 cases were diagnosed intrahepatic cholangiocarcinoma，and 4 cases were non-intrahepatic cholangiocarcinoma.The sensitivity of CT was 100.0%，the specificity of CT was 50.0%， and the accuracy of CT was 86.7%.The sensitivity of MRI was 100.0%，the specificity of MRI was 100.0%， and the accuracy of MRI was 100.0%.The diagnostic accuracy of combined detection was 100.0%，which was higher than that of CT (86.7%)，with significant difference (P<0.05).Conclusion The diagnosis of intrahepatic cholangiocarcinoma patients using CT combined with MRI technology has high accuracy，which can rapid accurate understand the development of the lesion of patients，with higher diagnostic value，it is worthy of clinical promotion and application.
[Key words]CT；MRI；Intrahepatic cholangiocarcinoma；Diagnosis
肝内胆管癌(intrahepatic cholangiocarcinoma，ICC)起自肝内胆管的上皮细胞，占胆管癌的10%[1]。肝内胆管癌是指原发于左右肝管汇合部至胆总管下端的肝外胆管恶性肿瘤，可分为肝门部胆管癌或上段胆管癌、中段胆管癌和下段胆管癌3个类型[2]。原发性胆管癌较少见，男女之比为1.5～3.0。发病年龄多为50～70岁，但也可见于年轻人。患者的临床症状主要表现为右上腹疼痛、消化道症状(消化功能紊乱，如恶心、呕吐、厌食、厌油、稀便等)、黄疸、发热、右上腹肿块等[3]。肝内胆管癌是一种恶性肿瘤疾病，会给患者的身体造成较大影响，需要及时进行诊断鉴别，关于肝内胆管癌的诊断也一直是临床研究中的重点内容之一，病理诊断可作为临床诊断金标准[4-5]。本研究选取我院收治的肝内胆管癌患者作为研究对象，探讨CT、MRI技术在肝内胆管癌诊断治疗中的联合应用价值，现报道如下。
1资料与方法
1.1一般资料
选取我院肝胆胰肿瘤外科2014年3月～2016年3月收治的30例肝内胆管癌患者作为研究对象，其中男性17例，女性13例；年龄为42～65岁，平均(54.8±2.3)岁；病程2～13个月，平均(6.1±1.3)个月。本研究所有患者均签署知情同意书，且经我院医学伦理学委员会批准。
1.2方法
所有患者均行CT平扫及增强扫描、MRI检查。采用西门子多排螺旋CT机，在检查前要求患者禁食4 h，行横断面检查，层厚与间距均为5 mm，患者取仰卧位，先进行平扫，扫面的位置从膈顶部到肾脏下缘，然后进行增强扫描，使用非离子型对比剂，经肘静脉注射，剂量80～100 ml，流速为3.0 ml/s，注射开始后的20～30 s进行扫描。采用西门子1.5T MRI超导型扫描仪，进行MRI平扫和增强扫描，层厚5～6 mm，层间距0.5～0.6 mm，行横断面、冠状面、矢状面扫描，矩阵(205～226)×256，扫描序列包括轴位T1WI/SE和T2WI/SE，注射对比剂采用钆喷酸葡胺注射液，经肘静脉快速注射，剂量0.01 mmol/kg，然后行增强扫描。 (曾燕辉 帅国强)
[关键词]CT；MRI；肝内胆管癌；诊断
[中图分类号] R445.2 [文献标识码] A [文章编号] 1674-4721(2017)04(c)-0122-03
[Abstract]Objective To explore the combined application value of CT and MRI in the diagnosis of intrahepatic cholangiocarcinoma.Methods 30 patients with intrahepatic cholangiocarcinoma in our hospital from March 2014 to March 2016 were selected as the research object，CT plain scan and enhanced scan，MRI examination was given respectively.The sensitivity，specificity and accuracy of CT，MRI and combined diagnosis were statistically analyzed.Results In pathological diagnosis，30 cases were diagnosed intrahepatic cholangiocarcinoma，and 4 cases were non-intrahepatic cholangiocarcinoma.The sensitivity of CT was 100.0%，the specificity of CT was 50.0%， and the accuracy of CT was 86.7%.The sensitivity of MRI was 100.0%，the specificity of MRI was 100.0%， and the accuracy of MRI was 100.0%.The diagnostic accuracy of combined detection was 100.0%，which was higher than that of CT (86.7%)，with significant difference (P<0.05).Conclusion The diagnosis of intrahepatic cholangiocarcinoma patients using CT combined with MRI technology has high accuracy，which can rapid accurate understand the development of the lesion of patients，with higher diagnostic value，it is worthy of clinical promotion and application.
[Key words]CT；MRI；Intrahepatic cholangiocarcinoma；Diagnosis
肝内胆管癌(intrahepatic cholangiocarcinoma，ICC)起自肝内胆管的上皮细胞，占胆管癌的10%[1]。肝内胆管癌是指原发于左右肝管汇合部至胆总管下端的肝外胆管恶性肿瘤，可分为肝门部胆管癌或上段胆管癌、中段胆管癌和下段胆管癌3个类型[2]。原发性胆管癌较少见，男女之比为1.5～3.0。发病年龄多为50～70岁，但也可见于年轻人。患者的临床症状主要表现为右上腹疼痛、消化道症状(消化功能紊乱，如恶心、呕吐、厌食、厌油、稀便等)、黄疸、发热、右上腹肿块等[3]。肝内胆管癌是一种恶性肿瘤疾病，会给患者的身体造成较大影响，需要及时进行诊断鉴别，关于肝内胆管癌的诊断也一直是临床研究中的重点内容之一，病理诊断可作为临床诊断金标准[4-5]。本研究选取我院收治的肝内胆管癌患者作为研究对象，探讨CT、MRI技术在肝内胆管癌诊断治疗中的联合应用价值，现报道如下。
1资料与方法
1.1一般资料
选取我院肝胆胰肿瘤外科2014年3月～2016年3月收治的30例肝内胆管癌患者作为研究对象，其中男性17例，女性13例；年龄为42～65岁，平均(54.8±2.3)岁；病程2～13个月，平均(6.1±1.3)个月。本研究所有患者均签署知情同意书，且经我院医学伦理学委员会批准。
1.2方法
所有患者均行CT平扫及增强扫描、MRI检查。采用西门子多排螺旋CT机，在检查前要求患者禁食4 h，行横断面检查，层厚与间距均为5 mm，患者取仰卧位，先进行平扫，扫面的位置从膈顶部到肾脏下缘，然后进行增强扫描，使用非离子型对比剂，经肘静脉注射，剂量80～100 ml，流速为3.0 ml/s，注射开始后的20～30 s进行扫描。采用西门子1.5T MRI超导型扫描仪，进行MRI平扫和增强扫描，层厚5～6 mm，层间距0.5～0.6 mm，行横断面、冠状面、矢状面扫描，矩阵(205～226)×256，扫描序列包括轴位T1WI/SE和T2WI/SE，注射对比剂采用钆喷酸葡胺注射液，经肘静脉快速注射，剂量0.01 mmol/kg，然后行增强扫描。 (曾燕辉 帅国强)