| ObjectiveTo investigate the value of combinative utilization of Ultrasonography, CT and MRI in the hailer cholangiocarcinoma diagnosis.Materials and methods64 cases of cholangiocarcinoma were collected as the research subjects. All the cases have different degree of jaundice, discomfort in upper abdomen, bursting pain, lacking of appetite, vomiting and sick, fatigue and the patients become thinner. Some patients suffer from the symptoms of recurrent bile duct infections, prorates, bursting pain in upper abdomen, clay color of stool. They were examined by Ultrasonography (Philips, IE33), CT (Siemens, Emotion 16), and MRI (GE, Signa 1.5T), respectively.The patients had to take 4h to 6h conventional fast before CT examination. 800ml water is drunk by the patient half hour before the scanning. An intramuscular injection with 654-210ml is given to the patient, following by another intake of 300ml to 500ml water. The scanning range is from phoenix top to kidney lower pole, the scanning method is helical scan, matrix 512×512, 110KV, 120MA, thickness 5.0mm, pitch 1.375:1, plain scanning, dual-phase dynamic contrast-enhanced scanning and delayed scanning, non-ionic iodine contrast agent Iobitridol (300mgI/mL), speed 3.0 ML/S, total usage 80-100mL., scanning is made 25S, 60S and 180S after the injection done, according to arterial, portal venous phase and extension phase scanning. Based upon the axial image, reconstruction treatment is taken to the thin volume data in workstation. The MPR images from region of interest, CPR (curved planar reformation) images, MIP (maximum intensity projection) images are obtained through this stage.Patients will take an intramuscular injection of 654-2 by 10ml and oral intake Ferric Ammonium iron (III) citrate by 10ml 10minutes before the examination. Department of phased array body coil control column is used for the scanning. Scanning sequence is as following:①Axial SE sequence T1W1 (TR500-600ms, TE 14-21ms) ,T2WI (TR6000-8000ms, TE85ms), starting scanning from phoenix top to the lower edge of the liver, thickness 6mm, spacing 2mm;②coronal axis vector 2D FIESTA scanning (TR 4.2ms, TE 1.7ms);③MRCP has exploited 2D coronal scan (TR 12000-1500ms, TE220ms), or 3D (TR4000ms, TE672ms) reconstructi- on.④Spoiled gradient echo (SPGR) dynamic contrast-enhanced sequence (TR150-180ms, TE2.0ms, flip angle 60 degree) , finish the total hepatic scan within one breath-hold (12-18S), contrast agent is GD-DTPA, dose 15-20ml, speed 3ml/s, since the start of injection, operate scanning after 15S, 30S, 60S, 90S, 120S, 150S and 180S.The diagnosis is made respectively for the cause of intrahepatic biliary dilatation, site of obstruction and the degree of metastasis. The results will be compared to the surgery and pathology one by one. Two independent film readers will observe the CT images and other image data to make diagnosis of hilar cholangiocarcinoma on their own. Double-Blind film reading methods is applied for both of the film readers to find out the diagnose accordance rate. The confidence scores will be evaluated to the two film readers and methods accordingly. The estimate will be made to the sensitivity, specificity, positive predictive value, negative predictive value, the accuracy rate, You den Index, positive likelihood ratio and negative likelihood ratio of the diagnosis of hilar cholangiocarcinoma combining usage of CT and other image data.ResultsWhen the two independent film readers make the diagnosis individually using CT images only or combining CT image and other image data, the accordance rate is 91.2% and 95.2% respectively. There is no statistical significance (χ~2=2.14,P=0.1432﹥0.05). However, the diagnosis consistency is increased between two film readers (K-Value 0.61 and 0.72). The confidence scores have statistical significance between two different diagnosis methods (p=0.0285﹤0.05). The confidence score is significantly increased using CT images combined with MR image to diagnose the hilar cholangiocarcinoma. Based on comprehensive use of various imaging data to make the diagnosis of hilar cholangiocarcinoma, the sensitivity, specificity, positive predictive value, negative predictive value, the accuracy rate are 94.8%, 96.3%, 98.4%, 88.1%, 95.2% respectively. You den Index is 91.1%, positive likelihood ratio is 25.6 and negative likelihood ratio is 0.04.The diagnosis accordance rate is 94.8% and 83.9% based on using comprehensive use of various imaging data to diagnose hilar cholangiocarcino- ma and the degree of metastasis. This diagnosis accordance rare is slightly higher. However, there is no statistical significance between the two methods (χ~2=3.4592,p=0.0629).Among the 64 cases, Ultra Sound points out 46 cases of hilar cholangiocarc- inoma, the diagnosis rate is 71.86% (46/64). CT points out 54 cases out of 64 and the diagnosis rate is 84.37%. CT images show hilar soft tissue lumps and intrahepatic bile duct dilatation. The MRI images show clearly hilar soft tissue masses and intrahepatic bile duct dilatation. Dynamic MR imaging also shows the masses are increased gradually in 60 cases. Other 4 cases, it shows artery phase is enhanced. All the examination using MRCP is successful. The diagnosis rate is 100% in locating the site of obstruction and description of intrahepatic bile duct dilatation.ConclusionThere is no statistical significance between two independent film readers based on CT Images only or comprehensive use of various imaging data to diagnose the hilar cholangiocarcinoma. Nevertheless, comprehensive use of various imaging data can increase the diagnosis confidence and also improve the diagnosis accordance between different film readers.Ultrasound, CT and MRT are all the effective examination methods for hilar cholangiocarcinoma. Ultrasound and CT examination can be combined together to confirm diagnosis and treatment programme. MRI is more valuable in revealing the size of the lumps in Klatskin section, the range of the lumps, infiltration of bile duct wall, portal vein involvement and enlargement of lymph nodes than CT and Ultrasound. MRI plain scan and dynamic enhanced MRI scan combing MRCP has relatively high Diagnostic value. |
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