摘要
目的评价应用超声造影技术(contrast-enhanced ultrasound,CEUS)与核磁共振成像(magnetic resonance imaging,MRI)在肝外胆管癌(extrahepatic cholangiocarcinoma,EHCC)诊断中的效果差异.方法选择2015-01/2017-12间我院确诊的肝外胆管癌患者46例(ECHH组),并选择同时期确诊的肝外胆管结石46例(CBDS组)以及胰头癌/十二指肠乳头疾病患者46例(PD组),分别使用B超(B-mode ultrasonography,BUS)、CEUS和MRI检查,以病理学诊断作为"金标准",应用受试者工作曲线(receiver operating characteristic curves,ROC)比较三种检查方式对于ECHH的诊断价值以及诊断效能(包括诊断准确率、敏感性、特异性、阳性预测值和阴性预测值等).结果 CEUS和MRI在动脉期的增强水平间不存在统计学差异(χ~2=1.105,P=0.602);CEUS在门脉期和延迟期显示低增强的比例分别为86.96%和100.00%,明显高于MRI的13.04%和13.04%(χ~2=50.261,70.769;P=0.000,0.000).ROC曲线显示,应用MRI和CEUS诊断肝外胆管癌的曲线下面积(area under curve,AUC=0.924,0.897)较高,而BUS较低(AUC=0.690).BUS诊断肝外胆管癌的准确率、灵敏度、特异度、阳性预测值和阴性预测值均显著低于CEUS(χ~2=0.175,0.066,11.467,37.260,6.328;P=0.000,0.010,0.001,0.000,0.012)和MRI(χ~2=0.227,0.098,13.378,41.170,9.082;P=0.000,0.002,0.000,0.000,0.003),CEUS和M R I诊断肝外胆管癌的各项诊断效能间不存在统计学差异(χ~2=0.464,0.383,0.000,0.001,0.334;P=0.496,0.536,1.000,0.972,0.563).结论超声造影技术在肝外胆管癌诊断中具有较高的价值,可以作为与核磁共振成像的重要补充.
AIM To compare the value of contrast-enhanced ultrasound and magnetic resonance imaging in the diagnosis of extrahepatic cholangiocarcinoma （EHCC）.METHODS Forty-six patients with extrahepatic cholangiocarcinoma （ECHH group） diagnosed at our hospital from January 2015 to December 2017 were enrolled. Forty-six patients with extrahepatic bile duct stones （CBDS group） and 46 patients with pancreatic head carcinomas or duodenum papilla disease （PD group） were also included. All patients underwent B-mode ultrasonography （BUS）, CEUS, and MRI. Using the pathological diagnosis as the ＂gold standard＂, the receiver operating characteristic （ROC） curves were plotted to compare the diagnostic efficacy （including diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value） of the three examination methods for EHCC.RESULTS There was no significant difference between CEUS and MRI in the arterial phase （χ2 = 1.105, P = 0.602）. CEUS showed low enhancement in 86.96% and 100.00% of patients in the portal phase and delayed phase, respectively, which were significantly higher than those of MRI （13.04% and 13.04%, respectively; 2 = 50.261, 70.769; P = 0.000, 0.000）. The ROC curve analysis showed that the area under the curve （AUC） of MRI and CEUS for the diagnosis of EHCC was higher that of BUS （0.924, 0.897 vs 0.690）. The diagnostic accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of BUS for EHCC were significantly lower than those of CEUS （Z2 = 0.175, 0.066, 11.467, 37.260, 6.328; P = 0.000, 0.010, 0.001, 0.000, 0.012） and MRI （Z2= 0.227, 0.098, 13.378, 41.170, 9.082; P = 0.000, 0.002, 0.000, 0.000, 0.003）. There was no significant difference in the diagnostic efficacy of CEUS and MRI for EHCC （χ 2= 0.464, 0.383, 0.000, 0.001, 0.334; P = 0.496, 0.536, 1.000, 0.972, 0.563）.CONCLUSION CEUS has high value in the diagnosis of EHCC and can be used as an important complement to MRI.
作者
朱伟年
Wei-Nian Zhu(Department of Ultrasound, Changxing Traditional Chinese Medicine Hospital, Changxing 313100, Zhejiang Province, China)
出处
《世界华人消化杂志》
CAS
2018年第13期796-802,共7页
World Chinese Journal of Digestology
关键词
超声造影技术
核磁共振成像
肝外胆管癌
敏感性与特异性
Contrast-enhanced ultrasound
Magnetic resonance imaging
Extrahepatic cholangiocarcinoma
Sensitivity and specificity
