肝门部胆管癌CT与MRI的综合诊断  

CT combined with MRI in the diagnosis of hilar cholangiocarcinoma

作　　者：鲁珊珊[1] 施海彬[1] 徐化凤[1] 徐青[1] 刘希胜[1] 

机构地区：[1]南京医科大学第一附属医院放射科,江苏南京210029

出　　处：《实用放射学杂志》2011年第10期1504-1507,共4页Journal of Practical Radiology

摘　　要：目的 探讨CT、MRI对肝门部胆管癌的综合诊断价值。方法收集31例肝门部胆管癌患者，均进行CT平扫、增强、MRI平扫及MRCP检查．10例进行MRI—LAVA检查。结果浸润型18例，3例CT未明确，MRI全部显示；结节肿块型10例，乳头状型3例，CT、MRI均检出。CT平扫病灶以等低密度为主，T2WI为稍低或等信号，T2WI不均匀稍高信号。动脉期主要呈边缘线样强化，门脉期轻中度不均匀强化，延迟呈持续强化。MRI屁示门静脉侵犯8例，CT5例。MRCP清晰显示扩张胆管的形态，肿瘤管壁浸润表现为胆管走行僵硬、不规则狭窄或中断。LAVA扫描6例受累胆管壁延迟强化。其他征象有肝内转移5例，淋巴结转移6例，病灶肝叶萎缩10例、肝叶低灌注1例。结论CT及MRI均能有效检出肝门部胆管癌。MRI在显示肿瘤边界，诊断浸润型胆管癌、门静脉侵犯及管壁浸润较CT可能更有优势。两者综合应用对肝门部胆管癌诊断更可靠。Objective To evaluate the value of the combination of CT and MRI in the diagnosis of hiiar cholangiocareinoma（HC）. Methods Thirty-one patients with HC confirmed pathologically were enrolled in this study. All patients underwent CT,plain MRI and MRCP, 10 cases of them underwent MRI-LAVA simultaneously. Results Infiltrating and nodal like type were observed in 18 and 10 cases, respectively. All foci were detected by MRI,while 3 cases of infiltrating type were missed by CT. Only 3 cases demon- strated as papillary-like type. The tumors showed as hypo-or iso-density on plain CT, slightly hypo-intensity on T1WI and mild byper-intensity on T2WI. After contrast-enhanced CT or MRI, most of the tumors showed mild, limbic or inhomogeneous enhancement in artery phase and venous phase. And they were characterized by lasting enhancement in delay phase. Potal vein involvement was detected in 8 cases by MRI and 5 cases by CT. MRCP could demonstrate the bile duct tree well. The infiltrated bile ducts were usually stiff, stenotic or discontinueous and were hyper-intense in 6 cases on delay T2WI of LAVA. Other indirect signs included intrahepatic metastases in 5 cases,lymph node metastases in 6 cases,atrophy of involved liver lobes in 10 cases and hypoperfusion in one case. Conclusion Both CT and MRI are effective methods in depicting HC. MRI seems more valuable than CT on presentation of tumor＇s border, infiltrating type, portal vein involvement and neoplastic periductal spread. CT combined with MR imaging will not only improve the diagnostic rate of HC, but also offer some evidences for clinical treatment.

关 键 词：肝 胆管癌 体层摄影术 X线计算机 磁共振成像 

分 类 号：R735.8[医药卫生—肿瘤] R814.42[医药卫生—临床医学]