MRI联合序列扫描诊断管内生长型胆管癌的临床价值探讨  

Clinical Evaluation of MRI United-Sequences Examination in Diagnosing Intraductal Growing Cholangiocarcinoma

作　　者：印隆林[1] 宋彬[2] 管英[1] 李迎春[1] 陈光文[1] 赵黎明[1] 赖力[1] 

机构地区：[1]四川省医学科学院、四川省人民医院放射科,成都610072 [2]四川大学华西医院放射科,成都610041

出　　处：《临床放射学杂志》2014年第8期1187-1192,共6页Journal of Clinical Radiology

摘　　要：目的探讨高场强MRI联合序列扫描诊断管内生长型胆管癌(IDCC)的临床价值,并分析肿瘤影像学表现的病理学基础。方法回顾性分析2007年9月至2013年8月间11例经手术病理证实IDCC的MRI表现,所有患者均接受完整的MRI序列检查。重点观察肿瘤的位置、形态、强化形式;肿瘤单发或多发;肿瘤部位胆管壁及胆管腔的改变;肿瘤近端、远端胆管是否扩张;肿瘤邻近结构是否受侵。结果 11例IDCC肿瘤形态呈乳头状、息肉状或铸型。9例多发,2例单发。10例肿瘤部位胆管腔扩大,胆管壁未见增厚或稍增厚,胆管外壁光整、内壁毛糙或光整;1例肿瘤部位胆管腔未见扩张,胆管壁不均匀增厚且内、外壁毛糙。5例肿瘤近端及远端胆管同时扩张。10例动态增强扫描表现为廓清或缓慢持续强化,平衡期信号强度低于肝实质;1例为进行性强化,平衡期信号强度等于肝实质。仅1例侵犯胆管邻近结构。结论 MRI联合序列扫描可以准确描述IDCC的各种影像学特征,综合分析其影像学表现可以正确诊断IDCC并与其他胆管癌亚型鉴别。Objective To investigate the clinical value of high-intensity field MRI united-sequences scanning in diagnosing intraductal growing cholangiocarcinoma （ IDCC）, and to analyze the histological basis related to the MRI features. Methods During the period from Sep. 2007 to Aug. 2013, 11 patients with pathologically-proved IDCC were admitted to authors^hospital. MRI scanning with united-sequences was carried out in all patients. The location, shape and enhancement pattern of the tumor, the number （single or multiple） of the lesions, the changes of biliary duct wall and lumen at the tumor area, the dilatation of proximal and distal bile ducts, and the involvement of the structure around the tumor were determined. The results were analyzed. Results In 11 cases with IDCC, the tumors assumed papillary, polypoid or casting appearance. The lesion was multiple in 9 cases and single in 2 cases. Dilated bile duct lumen, slightly thickened bile duct wall with smooth outer wall and smooth or rough inner wall were demonstrated in 10 cases. However, in the remaining one case, no dilated bile duct lumen was seen although irregular thickened bile duct wall with rough outer and inner wall at tumor area was revealed. Both proximal and distal bile ducts were dilated in 5 cases. Multi-phase dynamic contrast-enhanced MRI scanning was employed in 10 cases. Complete clearance of contrast, or slow and persistent enhancement was seen in 10 cases, and at balance-phase the signal intensity of the tumor was lower than that of the liver parenchyma. Progressive enhancement was observed in one case, and at balance-phase the tumor showed iso-intensity signal similar to the signal of the liver parenchyma. Involvement of the adjacent structures was detected in only one case. Conclusion MRI united-sequences examination can accurately display all imaging features of IDCC. Comprehensive analysis of all tumor imaging findings can help make a correct diagnosis of IDCC and help differentiate IDCC from other sub-type cholangiocarcinomas.

关 键 词：胆管癌 管内生长型 胆胰管水成像 磁共振成像 

分 类 号：R735.8[医药卫生—肿瘤] R445.2[医药卫生—临床医学]