Application Of Multimodal Imaging Technique In The Classification Of Hepatic Cystic Echinococcosis

Objective:To investigate the value of multimodal imaging technology in the typing of hepatic cystic echinococcosis（HCE）,the viabiliity of HCE typing to reflect the lesion,and the application of CT value and MRI apparent diffusion coefficient（ADC）in the typing and activity of HCE.Methods:A total of 309 HCE patients with 412 hydatids confirmed by surgery and pathology were involved by ultrasound,CT and MRI in our hospital,and98 lesions of extrahepatic lesions were classified into 5 types according to WHO classification standard vertebrae.This study is divided into two parts,one is to explore the application value of multimodal imaging technology in HCE typing,the other is to study the evaluation of CT and MRI on HCE typing and activity,the content is as follows:1.The sensitivity and specificity of the three methods in diagnosing various types of lesions were calculated,and the consistency was compared with Mc Nemar test.2.The serum ferritin（SF）,the other laboratory indicators and the size of the lesions were calculated,and the differences were compared by ANOVA or Kruskal-Wallis H test;3.Calculate the number of fat droplets,biliary fistula and metastasis of other organs that detected by the three methods respectively;4.The individual results of CT and MRI（CT value,ADC value）analyzed with CT and MRI findings（CT value 1,ADC value 1）,are respectively for various lesions cystic fluid measurement,calculation of CT value of liver cystic hydatid type 5,ADC values,CT value1,ADC value1 using analysis of variance and rank correlation test,after the data statistics of each type of measurement results are completed,the ROC curve is drawn and the critical value is obtained.Results:1.Among the 309 patients,67 lesions of CE1,51 lesions of CE2,55 lesions of CE3,57 lesions of CE4 and 37 lesions of CE5 were detected by ultrasound and CT,respectively;65 lesions of CE1,65 lesions of CE2,68 lesions of CE3,57 lesions of CE4 and 33 lesions of CE5 were detected by MRI.The sensitivity and specificity of ultrasound and CT were the same,CE1-CE5 were 96.3%94.5%,78.5%100%,76.3%100%,100%94.8%,100%98.6%,respectively.The Kappa coefficients were 0.837,0.852,0.868,0.872 and 0.936,respectively.The sensitivity and specificity of MRI for CE1 type were 97.0%and 99.2%,the sensitivity and specificity of CE2-CE3 type were 100%,the sensitivity and specificity of CE4 type and CE5 type were 81.4%100%,89.2%and 100%,respectively.The Kappa coefficients were 0.962,1.000,1.000,0.872,0.936,respectively.There was no significant difference between CT and MRI（χ2=1.964,P>0.05）.2.According to the surgical pathology classification count,CE1 type 69 lesions,65 lesions of type CE2,CE3 type 68 lesions,70 lesions of type CE4,CE5 37 lesions,each model of SF,DBIL and IBIL,ALT,AFP,long diameter and short meridian,SF,IBIL,long diameter,short meridian,the statistically significant（P<0.05）,AFP,DBIL,ALB,ALT had no statistical difference（P>0.05）.3.The proportions of lesions with biliary fistula detected by ultrasound,CT and MRI were 3.9%,7.4%and 10.3%,respectively;The combined lipid droplets accounted for 3.2%,9.7%and 11.3%,respectively.There were 98 lesions of extrahepatic lesions,the detection rates of ultrasound,CT and MRI were 45.9%,96.9%and 89.7%,respectively.4.CT value 1,ADC value 1,CT value and ADC value of type 5 lesions were respectively:CE1 type（5.38±1.94）HU（3.33±0.27）×10^-3mm²/s（5.38±1.94）HU（3.33±0.27）×10^-3mm²/s、CE2 type（7.44±2.67）HU（3.16±0.17）×10^-3mm²/s（7.62±2.67）HU（3.16±0.17）×10^-3mm²/s CE3 type（21.86±4.99）HU（2.62±0.24）×10^-3mm²/s（22.07±5.89）HU（2.62±0.24）×10^-3mm²/s CE4 type（33.63±5.38）HU（2.42±0.11）×10^-3mm²/s（33.63±5.38）HU（2.43±0.11）×10^-3mm²/sCE5 type（103.28±36.98）HU（2.20±0.086）×10^-3mm²/s（103.28±36.96）HU（2.29±0.21）×10^-3mm²/s,CT value ₁,ADC value 1,CT value,ADC value comparison,the difference was statistically significant（P<0.05）,among which,pair comparison between CE1,CE2 type and CE3,CE4,CE5 type showed statistically significant difference（P<0.05）,there was no significant difference between CE1 type and CE2 type（P>0.05）,and each type of CT value1 gradually increased;The ADC values of CE1,CE2,CE3,CE4 and CE5 showed statistically significant difference（P<0.05）,and the ADC value1 in all types of lesions gradually decreased.There was a negative correlation between CT value1 and ADC value1（r=-0.657）.The ROC curves were drawn.The areas under the curves of CT value 1,ADC value 1,CT value and ADC value were 96.2%,99.8%,91.0%and 99.1%,respectively.Conclusion:By comparing the sensitivity and specificity of each type with the three methods,CT and MRI can show more clearly the characteristic signs of each type of hepatic cystic hydatid lesions,and MRI is more accurate in the classification diagnosis,and has its unique advantages in the formation of lipid droplets and biliary fistula.At the same time,the quantitative indicators of CT value and ADC value were used to diagnose the activity of various types of lesions more accurately.The CT value and ADC value in different types of hepatic cystic hydatid were different,which could indirectly reflect the activity of lesion growth.