混合型肝癌的CT、MRI表现及临床病理分析  

CT/MRI appearances and clinical pathological analysis of mixed hepatocarcinoma

作　　者：陆伦[1] 邵丹丹[1] 龙行安[1] 王雪雪[1] 程红岩[1] 

机构地区：[1]第二军医大学附属东方肝胆外科医院放射科,上海200438

出　　处：《实用放射学杂志》2013年第4期579-582,共4页Journal of Practical Radiology

摘　　要：目的探讨混合型肝癌的CT、MRI表现及临床病理特点分析。方法回顾性收集经手术及病理确诊的混合性肿瘤39例的临床资料及CT、MR图像，分析其临床病理特征及CT、MRI上的表现。结果39例患者，70％病灶位于右叶，90％患者合并乙型肝炎和（或）69％合并肝硬化，56％AFP升高，44％CAl99升高，其中23％AFP及CAl99同时增高。23％出现子灶及门脉侵犯、8％肝内胆管扩张及胆管侵犯、13％淋巴结转移，5％远处转移。39例中7例应属肝双原发癌（18％），32例属混合型肝细胞一胆管癌（82％）。增强后9例（23％）（双原发癌3例；混合型肝细胞一胆管癌6例）有较典型表现：双原发癌表现为肝细胞癌灶动脉期均匀强化或部分强化，门脉期及延迟期强化减退；胆管细胞癌灶动脉期无明显强化或边缘强化，门脉期及延迟期边缘强化延续。混合型肝细胞一胆管癌表现为癌灶动脉期有部分强化及部分边缘强化，门脉期及延迟期部分强化减退及部分边缘强化持续。结论本病缺乏特异性临床表现，三期增强CT、MRI检查有助于病变检出，但术前确诊仍较为困难，最终诊断有赖于病理学检查。Objective To analyze clinical and pathological characteristics, image manifestations {spiral CT and high field strength MRI） of mixed hepatoearcinoma. Methods 39 patients with mixed hepatocarcinoma confirmed by operation and pathology were in volved in this study. The clinical data and CT/MR imaging findings of mixed hepatocarcinoma were retrospectively analyzed. Results 39 cases of mixed hepatocarcinoma. The lesions were mainly located in the right lobe {70% ）. The patients were associated with hepatitis B （ 90 ~ ） and （ or ） cirrhosis { 69 ~ ）, AFP elevation （ 56 % ）, CA199 elevation { 44 ~ ）, both elevation simultaneously of AFP and CA199 （ 23 % ）. Satellite lesions （ 23 % ）, portal vein invasion （23 % ）, dilatation of intrahepatic bile duct （ 8 % ） , bile duct invasion（8%）, lymph node metastasis {13%） and distant metastasis （5%） were detected. In totall 39 cases, 7 cases {18%） were double primary cancer and 32 cases were mixed hepatoearcinoma（ 82% ）. At contrast-enhanced scan, the lesions in 9 cases （23~） had typical presentations, including double primary cancer in 3 cases （ 43 %, 3/7） , mixed hepatocarcinoma in 6 cases （ 19 %, 6/32 ）. Double primary cancers showed homogeneous or partial enhancement in hepatocellular carcinoma loci in the arterial phase and en- hancement declined in portal and delayed phase. Bile duct ceil loci were no of enhancement or peripheral enhancement in arterial phase, and peripheral enhancement continually in portal and delayed phases. The loci in mixed hepatocarcinoma showed partial and edge enhancement in arterial phase, strengthening diminished and some edge enhancement continued in portal and delayed phase. Conclusion The clinical characteristics of combined hepatocellular carcinoma and eholangiocarcinoma are no of specificity, but there is a certain value in diagnosis of typical performances with enhanced CT and MRI. The preoperative diagnosis of this disease is still more difficult, the final diagnosis depends o

关 键 词：肝 肝痛 计算机体层成像 磁共振成像 病理 

分 类 号：R735.7[医药卫生—肿瘤] R446.8[医药卫生—临床医学]