Evaluation Of Prognosis And Treatment Of Hilar Cholangiocarcinoma By Magnetic Resonance Multisequence Imaging

Objective:Hilar cholangiocarcinoma(HC)has a special location,radical resection is the only possible treatment,and preoperative assessment of liver function and prediction of pathological differentiation are necessary.At present,there are few reports about the long-term postoperative prediction of HC patients undergoing HC surgery with the help of imaging.The common evaluation methods of liver function in HC have some defects.In view of the above problems,this study included imaging factors to retrospectively analyze the related factors of the prognosis of HC radical surgery.Intravoxel incoherent motion(IVIM)was used to evaluate the degree of tumor differentiation and to evaluate the liver function and the therapeutic effect of xtracorporeal biliary drainage.Gd-BOPTA enhanced magnetic resonance scanning was used to evaluate the degree of tumor differentiation and liver function in patients with hilar cholangiocarcinoma.Methods:(1)89 patients with hilar cholangiocarcinoma underwent radical operation from2009 to 2013 were collected.According to the degree of cholangiectasis by magnetic resonance cholangiopancreatogrphy(MRCP),the patients'general conditions and elevant pathological data were analyzed.The differences of liver function test items and carbohydrate antigen 199(CA19-9)levels in different degrees of biliary ilatation were compared;the differences of general conditions and tumor athological characteristics in patients with different degrees of biliary dilatation were analyzed;the independent factors affecting prognosis by Kaplan Meier method and Cox proportional risk regression model were analyzed.(2)37 patients with hilar cholangiocarcinoma treated by HC radical resection,56patients with hilar cholangio-carcinoma treated by external biliary drainage from 017 to 2019 were collected,and 30 healthy volunteers were collected as the control group.All subjects underwent conventional and Multi-b diffusion weighted MRI cans.The IVIM related parameters(ADCfast,ADCslow and f)of liver parenchyma of healthy volunteers and tumor and liver parenchyma of HC patients were easured;the degree of biliary dilatation in HC patients was analyzed;the IVIM arameter values of liver parenchyma before and after HC external biliary drainage treatment were measured;the liver function test results and model for end-stage liver disease(MELD)score values of all subjects were analyzed.To evaluate the onsistency and repeatability of data collection.To evaluate the data collection stability of different ROI measurement methods for tumors.To compare the differences in IVIM parameter values of extratumoral liver parenchyma between healthy controls and HC patients.To analyze the correlation between IVIM arameters of tumor parts of hilar cholangiocarcinoma and the degree of pathological differentiation.To analyze the correlation between IVIM parameters and liver unction items of hilar cholangiocarcinoma.To analyze the correlation between the degree of biliary dilatation and MELD score and IVIM parameters of hilar holangiocarcinoma.Comparison of IVIM parameters of liver parenchyma before and after external biliary drainage in patients with hilar cholangiocarcinoma and the correlation between IVIM parameters before and after drainage and TBil level after drainage.(3)In 37 patients with hilar cholangiocarcinoma,Gd-BOPTA enhanced canning was performed with an axial breath-hold fast three-dimensional perturbation gradient echo T1-weighted sequence(liver acpuisition with volume acceleration flex,LAVA-Flex).To measure and calculate the contrast enhancement ratio(CER)of umor and liver parenchyma and record the nerve involvement and the positive rate of immunohistochemistry.To compare the correlation between partial CER and athological differentiation of tumors.To compare the enhancement rate of epatobiliary phase in different stages of enhancement and different degrees of holangiectasis.The correlation between liver function items,MELD score and CER value of liver parenchyma in hepatobiliary phase was analyzed.To compare the ifference of CER value in hepatobiliary phase in different results of tumor immunohistochemistry indexes and nerve infiltration or not.Result:(1)The levels of aspartate transaminase(AST),aspartate transaminase(ALT),glutamyl transpeptadase(GGT)and CA19-9 in the severe biliary dilatation group were significantly higher than those in the mild to moderate biliary dilatation group;the degree of biliary dilatation was independently correlated with Bismuth-Corlette classification and tumor stage.Tumor differentiation and biliary dilatation were ndependent factors influencing5-year-overall survival(OS).Tumor stage, ifferentiation degree and biliary dilatation degree were independent factors of 3-year-disease-free survival(DFS).(2)The consistency of ADC_slow was the best.The parameters measured by the maximum plane method are more reproducible.The correlation between ADC_slowparameters and tumor pathological grade was the best.ADC_fast value of hepatic arenchyma in patients with hilar cholangiocarcinoma was significantly different in different differentiation of biliary dilatation and MELD scores.The correlation etween the level of TBil and MELD and ADC_fast of hepatic parenchyma was the highest.The level of TBil and MELD before drainage were correlated with the rainage effect.The change of ADC_fast was correlated with the decrease of TBil after drainage,There was no significant statistical difference in ADC_fast change values of liver parenchyma between the two groups of patients with TBil?50?mol/l and50?TBil?85?mol/l after drainage.(3)There was no significant difference in the degree of pathological ifferentiation of tumors according to the four enhancement methods,and there was significant difference in the CER value of hepatobiliary phase with different degree of pathological differentiation of tumors.There was significant difference in CER between Ki-67 negative group and positive group.The difference of CER value in hepatobiliary stage between the tumor pathological grading groups was less than that in mild and moderate cholangiectasis.TBil,AST,ALB and MELD were significantly correlated with CER in hepatobiliary phase.TBil is an independent factor.Conclusion:(1)The imaging evaluation of the degree of cholangiectasis can predict the prognosis of hilar cholangiocarcinoma.(2)The ADCslow value in IVIM technique can reflect the pathological ifferentiation of HC tumors without the influence of biliary dilatation;ADC_fast value of hilar cholangiocarcinoma can reflect part of liver function index and liver reserve function,ADC_fastwas correlated with the degree of cholangiectasis and MELD score.ADC_fast value of hepatic parenchyma is significant for the therapeutic effect of xtracorporeal drainage for hilar cholangiocarcinoma has predictive value.(3)The CER value of Gd-BOPTA enhanced scan in hepatobiliary phase reflects the degree of pathological differentiation of hilar cholangiocarcinoma,while the orrelation can be affected when the degree of cholangiectasis is severe;the CER value of hepatobiliary phase is related to the positive rate of some tumor mmunohistochemical markers,which can reflect the invasiveness of the tumor;The CER value of the liver parenchyma can reflect the liver function of HC patients,TBil is an independent factor of CER value of liver parenchyma and hepatobiliary phase in patients with hilar cholangiocarcinoma.