探讨增强CT在鉴别胆囊癌侵犯肝脏与肝癌累及胆囊病变中的应用价值

Diagnostic value of contrast-enhanced CT in differentiating gallbladder carcinoma invading the liver from liver cancer involving gallbladder lesions

摘要:

目的 探讨增强电子计算机断层扫描（computer tomography，CT）在胆囊癌侵犯肝脏与肝癌累及胆囊病变中的鉴别诊断价值。方法 收集2012年2月到2022年2月重庆医科大学附属第一医院115例患者临床及影像学资料，其中胆囊癌侵犯肝脏病例69例，肝癌累及胆囊病例46例，记录性别、年龄、肿瘤大小、肿瘤边界、胆囊形态、肝硬化、胆管扩张、肿瘤内或胆管系统内高密度影、门静脉癌栓、强化方式、强化程度、淋巴结肿大及远处转移共13个观察指标，并进行统计学分析。结果 性别（P=0.007）、年龄（P=0.002）、肿瘤大小（P=0.003）、肝硬化（P<0.001）、肿瘤内或胆管系统内高密度影（P=0.013）、门静脉癌栓（P<0.001）、强化方式（P<0.001）及淋巴结肿大（P=0.034）有统计学差异。通过回归分析筛选出年龄（敏感度为0.812，特异度为0.457）、肿瘤大小（敏感度为0.630，特异度为0.696）、门静脉癌栓（敏感度为0.326，特异度为0.957）、淋巴结肿大（敏感度为0.681，特异度为0.522）为显著分类指标，联合4个观察指标的参数绘制受试者工作特征（receiver operating characteristic，ROC）曲线，曲线下面积（area under the curve，AUC）为0.770，敏感度为0.674，特异度为0.826。结论 增强CT在鉴别胆囊癌侵犯肝脏与肝癌累及胆囊病变时，性别、年龄、肿瘤大小、肝硬化、肿瘤内或胆管系统内高密度影、门静脉癌栓、强化方式及淋巴结肿大有鉴别价值，同时结合年龄、肿瘤大小、门静脉癌栓及淋巴结肿大有助于提高鉴别诊断能力。

Abstract:

Objective To investigate the value of contrast-enhanced computer tomography（CT） in differential diagnosis between gallbladder carcinoma invading the liver and liver cancer involving gallbladder lesions.Methods The clinical and imaging data of 115 patients in our hospital from February 2012 to February 2022 were collected，including 69 cases of gallbladder cancer invading the liver and 46 cases of liver cancer involving the gallbladder. A total of 13 observation indexes were recorded and statistically analyzed，including their gender，age，tumor size，tumor borders，gallbladder morphology，liver cirrhosis， bile duct dilation，high-density shadow in tumor or bile duct system，portal vein tumor thrombus， enhancement mode，degree of intensification，enhancement mode，and distant metastasis.Results There was statistical significance in observation indexes，including gender（P=0.007），age（P=0.002），tumor size（P=0.003），liver cirrhosis（P<0.001），high-density shadow in tumor or bile duct system（P=0.013），portal vein tumor thrombus（P<0.001），enhancement mode（P<0.001） and lymph node enlargement（P=0.034）. Based on bivariate logistic regression analysis，four observation indexes were selected to be significant classification indicators，including age（sensitivity：0.812；specificity：0.457），tumor size（sensitivity：0.630；specificity：0.696），portal vein tumor thrombus（sensitivity：0.326；specificity：0.957） and lymph node enlargement（sensitivity：0.681；specificity：0.522）. The AUC of combined differentiation of four observation was 0.770，with a sensitivity of 0.674 and a specificity of 0.826.Conclusion When contrast-enhanced CT differentiates gallbladder carcinoma invading the liver from liver cancer involving gallbladder lesions，gender，age，tumor size，liver cirrhosis，high-density shadow in tumor or bile duct system，portal vein tumor thrombus，enhancement mode and lymph node enlargement are helpful for differential diagnosis. Meanwhile，combining with age，tumor size，portal vein tumor thrombus and lymph node enlargement is helpful to improve the ability of differential diagnosis.