摘要
目的探讨CT细胞外容积分数(ECV),联合CT征象术前预测肝内胆管癌(ICC)病理分型[大胆管型ICC(LD-ICC)和小胆管型ICC(SD-ICC)]的临床价值。方法回顾性收集本院2018年3月—2024年1月经病理证实的64例ICC患者,所有患者术前均行腹部多期增强CT扫描。计算病灶内高强化区高ECV(ECV_(1))、低强化区ECV(ECV_(2))及相对ECV(ECV _(r))=ECV_(1)-ECV_(2),采用单因素分析比较两组间临床资料、CT征象及ECV_(r)的差异,将具有统计学差异的变量纳入Logistic回归行多因素分析建立模型,并进一步评估该模型的预测效能。结果单因素分析两组间高ECV_(r)值、动脉期无环形强化、中央型、胆管扩张更提示诊断为LD-ICC。其中高ECV_(r)、胆管扩张、肿瘤位置是预测LD-ICC的独立影响因素,所得logistic回归模型ACU高达0.928(95%CI:0.866,0.991),敏感度84.0%,特异度92.3%。结论高ECV_(r)、胆管扩张、肿瘤位置是预测ICC病理分型的独立影响因素,CT联合模型具有良好的诊断效能。
Objective To investigate the clinical value of CT-based extracellular volume fraction(ECV)combining with CT features for the preoperative pathological classification of intrahepatic cholangiocarcinoma(ICC;Large duct-ICC,LD-ICC;Small duct-ICC,SD-ICC).Methods From March 2018 to January 2024,sixty-four patients with pathologically confirmed ICC who had available preoperative abdominal plain and enhanced CT images were retrospectively enrolled.The ECV of hyperenhancement region(ECV_(1))and that of hypoenhancement region(ECV_(2))in tumor was calculated and the relative ECV(ECV_(r))was defined as their difference.ECV_(r),CT features as well as clinical data,for differentiating LD-ICC from SD-ICC were compared using univariate and multivariate analyses,and a logistic regression model was then generated.The differential diagnostic efficiency of the logistic regression model was further evaluated.Results The univariate analysis showed that higher ECV_(r),fewer complete contours in arterial phase hyperenhancement,central type,intrahepatic duct dilatation were suggestive factors of LD-ICC.Higher ECV_(r) and intrahepatic duct dilatation,tumor location were independent factors for LD-ICC in multivariate analysis.The logistic regression model has achieved a favorable preoperative differential diagnositic performance in ICC pathological categorization.The AUC of the logistic regression model was up to 0.928(95%CI:0.866,0.991),with the sensitivity of 84.0%and the specificity of 92.3%.Conclusion Higher ECV_(r),intrahepatic duct dilatation,tumor location can be considered reliable CT indicators of LD-ICC.CT combined model can facilitate noninvasive prediction of ICC subtype with satisfactory predictive performance.
作者
陈良潇
黄豆豆
吴玉平
刘欣杰
游艳
CHEN Liangxiao;HUANG Doudou;WU Yuping;LIU Xinjie;YOU Yan(Department of Radiology,The Second Affiliated Hospital of Chongqing Medical University,Chongqing 400010,China;Department of Pathology,The Second Affiliated Hospital of Chongqing Medical Universityy,Chongqing 400010,China)
出处
《西部医学》
2024年第5期771-775,780,共6页
Medical Journal of West China
基金
2023年重庆市科卫联合医学科研项目(2023QNXM029)。
