混合型肝细胞胆管细胞癌（双表型）肿瘤：超声造影在诊断中的潜在作用。
Combined Hepatocellular Cholangiocarcinoma (Biphenotypic) Tumors: Potential Role of Contrast-Enhanced Ultrasound in Diagnosis.
机构信息
1 Department of Ultrasound, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, 651 Dongfeng Rd E, Guangzhou, Guangdong 510060, PRC.
2 Department of Pathology, Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, PRC.
出版信息
AJR Am J Roentgenol. 2017 Oct;209(4):767-774. doi: 10.2214/AJR.16.17513. Epub 2017 Aug 4.
OBJECTIVE
The objective of this study was to evaluate the diagnostic performance of contrast-enhanced ultrasound (CEUS) in differentiating combined hepatocellular cholangiocarcinomas (CHCs) from hepatocellular carcinomas (HCCs) and intrahepatic cholangiocarcinomas (ICCs).
MATERIALS AND METHODS
Thirty-three patients with pathologically confirmed CHC and matched control subjects with pathologically confirmed HCC (n = 30) or ICC (n = 32) who underwent preoperative CEUS from January 2005 to December 2015 were enrolled in this study. The CEUS images of the hepatic lesions were subjectively analyzed in consensus by two radiologists. The diagnostic performances were evaluated by ROC analysis.
RESULTS
In the arterial phase, hyperenhancement was more common in CHCs (76%) and HCCs (100%) than in ICCs (22%), whereas in the late phase marked washout was more common in CHCs (76%) and ICCs (100%) than in HCCs (10%). Using marked washout in the late phase to differentiate CHC from HCC, the area under the ROC curve (AUC) was 0.829, and the sensitivity, specificity, and accuracy were 78%, 90%, and 83%, respectively. Using hyperenhancement in the arterial phase followed by marked washout in the late phase to distinguish CHC from ICC, the AUC value was 0.663, and the sensitivity, specificity, and accuracy were 55%, 78%, and 66%.
CONCLUSION
Although the imaging features of CHC, HCC, and ICC on CEUS may overlap, CEUS could be used in the differential diagnosis of CHC from HCC and ICC.
目的
本研究旨在评估超声造影（CEUS）在鉴别肝细胞癌（HCC）与肝内胆管细胞癌（ICC）中的诊断性能。
材料与方法
本研究纳入了 2005 年 1 月至 2015 年 12 月期间接受术前 CEUS 的 33 例经病理证实的 CHC 患者和与之匹配的经病理证实的 HCC（n=30）或 ICC（n=32）患者。由两位放射科医生对肝脏病变的 CEUS 图像进行主观分析。采用 ROC 分析评估诊断性能。
结果
在动脉期，CHC（76%）和 HCC（100%）比 ICC（22%）更常见高增强，而在晚期，CHC（76%）和 ICC（100%）比 HCC（10%）更常见明显廓清。使用晚期明显廓清来鉴别 CHC 与 HCC，ROC 曲线下面积（AUC）为 0.829，灵敏度、特异性和准确率分别为 78%、90%和 83%。使用动脉期高增强，然后在晚期明显廓清来鉴别 CHC 与 ICC，AUC 值为 0.663，灵敏度、特异性和准确率分别为 55%、78%和 66%。
结论
尽管 CHC、HCC 和 ICC 在 CEUS 上的影像学特征可能重叠，但 CEUS 可用于 CHC 与 HCC 和 ICC 的鉴别诊断。
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