Asayama Yoshiki, Yoshimitsu Kengo, Irie Hiroyuki, Tajima Tsuyoshi, Nishie Akihiro, Hirakawa Masakazu, Nakayama Tomohiro, Kakihara Daisuke, Taketomi Akinobu, Aishima Shin-ichi, Honda Hiroshi
Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Fukuoka 812-8582, Japan.
Radiology. 2006 Jan;238(1):150-5. doi: 10.1148/radiol.2381041765. Epub 2005 Nov 22.
To retrospectively determine whether the degree of contrast material enhancement at delayed-phase dynamic computed tomography (CT) for intrahepatic cholangiocarcinoma (ICC) is related to the patient's prognosis after surgery.
Neither institutional review board approval nor informed consent was required for this retrospective evaluation. Thirty-two patients (22 men, 10 women; mean age, 60.8 years; range, 33-80 years) with mass-forming ICC underwent dynamic CT. Delayed CT images obtained 4-6 minutes after the injection of contrast material were evaluated by two radiologists. Patients were classified in consensus into one of two groups: Group 1 included those in whom more than two-thirds of the tumor showed enhancement on delayed-phase scans. Group 2 included those in whom less than two-thirds of the tumor showed enhancement on delayed-phase scans. The imaging findings were correlated with pathologic findings. Survival curves were drawn by using the Kaplan-Meier method, and the differences between the groups were compared with the log-rank test. Multivariate analysis was performed to clarify prognostic factors.
There were 13 patients in group 1 and 19 in group 2. The degree of enhancement on the delayed-phase images showed statistically significant correlation with the amount of fibrous stroma (P < .001) and the frequency of perineural invasion (P < .01). The survival rate in group 1 was significantly lower than that in group 2 (P = .016). Multivariate analysis revealed that enhancement of more than two-thirds of the ICC was a significant and independent prognostic factor.
The degree of enhancement on delayed-phase CT scans is a useful indicator for prediction of the prognosis of patients with mass-forming ICC.
回顾性确定肝内胆管癌（ICC）延迟期动态计算机断层扫描（CT）时对比剂增强程度是否与患者术后预后相关。
本回顾性评估无需机构审查委员会批准或患者知情同意。32例（22例男性，10例女性；平均年龄60.8岁；范围33 - 80岁）有肿块形成的ICC患者接受了动态CT检查。两名放射科医生对注射对比剂后4 - 6分钟获得的延迟CT图像进行评估。患者经一致意见分为两组之一：第1组包括延迟期扫描时肿瘤超过三分之二出现强化的患者。第2组包括延迟期扫描时肿瘤不到三分之二出现强化的患者。将影像学表现与病理结果进行关联。采用Kaplan - Meier法绘制生存曲线，并通过对数秩检验比较两组之间的差异。进行多因素分析以明确预后因素。
第1组有13例患者，第2组有19例患者。延迟期图像上的强化程度与纤维基质数量（P <.001）和神经周围侵犯频率（P <.01）呈统计学显著相关。第1组的生存率显著低于第2组（P =.016）。多因素分析显示，ICC超过三分之二出现强化是一个显著且独立的预后因素。
延迟期CT扫描的强化程度是预测有肿块形成的ICC患者预后的有用指标。
