MSCT联合肿瘤标志物对肝内肿块型胆管细胞癌的诊断价值

摘要

Objective:To discuss the value of MSCT in combination with tumor markers (CA19-9,CA125,CEA,AFP) examination in the diagnosis of mass type intrahepatic cholangiocarcinoma (IMCC).Methods:The clinical and imaging materials of 74 cases with hepatic mass lesion including 34 cases with IMCC and 40 cases with non-IMCC were retrospectively analyzed.The CT findings of 34 cases with IMCC were summarized,The accuracy of CT diagnosis was compared with that of CT in combination with using tumor markers (CA199,CA125 and CEA positive,AFP negative).Correlation analysis of tumor ize,degree of enhancement and tumor markers were performed.Results:The CT findings of IMCC were irregular in shape,low attenuation on plain CT images,and cystic necrosis,which were seen in 28 cases.The other 6 cases of IMCC with small size appeared as homogeneous in density.On arterial phase tumors in 16 cases showed mild ring like or reticulate enhancement,gradual enhancement could be assessed in portal and delay phases in 33 cases.Portal vein was invaded in 4 cases,atrophy of invaded liver lobe in 8 cases,retraction of adjacent liver capsule in 15 case and hepatic hilar or retroperitoneal lymph node metastases in 16 cases.The diagnostic accuracy of CT was 66.2％ (49/74 cases),and the accuracy of CT in combination with tumor markers was 83.8％ (62/74 cases),with significant statistic difference (P=0.000).Tumor size,degree of enhancement and tumor markers had no significant correlation.Conclusion:The typical CT findings of IMCC are mild marginal ring like enhancement in arterial phase,with progressive enhancement in portal and delayed phases.CT in combination with tumor markers could improve the diagnostic accuracy of IMCC effectively.No correlation was found in tumor size,enhancement and tumor markers.%目的:探讨MSCT联合肿瘤标志物(包括CA19-9、CA125、CEA、AFP)对肝内肿块型胆管细胞癌(IMCC)的诊断及鉴别诊断价值.方法:回顾性分析74例肝占位患者(包括34例IMCC和40例非IMCC患者)的影像及临床资料.总结、分析34例IMCC的CT表现;比较CT单独诊断IMCC及CT联合肿瘤标志物(CA19-9、CA125、CEA阳性,AFP阴性)诊断IMCC的准确率;进行肿瘤大小、强化程度与肿瘤标志物的相关性分析.结果:IMCC CT表现为形态不规则,平扫肿瘤均呈低密度,28例肿瘤内有囊变坏死区,6例体积较小者病灶内密度均匀.CT增强扫描动脉期肿瘤呈环状、网格状轻度强化者16例.门脉期和静脉期33例呈渐进性延迟强化,门脉受侵4例,所在肝叶萎缩8例,邻近肝包膜凹陷15例,肝门、腹膜后淋巴结转移16例.CT单独诊断IMCC的准确率为66.2％(49/74),CT联合肿瘤标志物的诊断准确率为83.8％(62/74),两者差异有统计学意义(P=0.000).肿瘤大小、强化程度与肿瘤标志物的相关性无统计学意义(P＞0.05).结论:IMCC的典型CT表现为动脉期轻度边缘环状强化,门脉期、静脉期呈渐进性强化;CT联合肿瘤标志物可以有效提高IMCC的诊断准确率;肿瘤大小、强化程度与肿瘤标志物无相关性.