胆管内乳头状肿瘤磁共振成像的诊断价值  

Value of MR imaging in the diagnosis of intraductal papillary neoplasm of the bile duct

作　　者：宋凤祥[1] 周俊[2] 施裕新[3] 曾蒙苏[1] 周康荣[1] 丁玉芹[1] 曹颖丽[1] 周建军[1] 

机构地区：[1]复旦大学附属中山医院放射科上海市影像医学研究所,200032 [2]上海市中医药大学附属曙光医院放射科 [3]上海市公共卫生临床中心影像科

出　　处：《中华肿瘤杂志》2015年第1期57-62,共6页Chinese Journal of Oncology

摘　　要：目的探讨胆管内乳头状肿瘤磁共振成像（MRI）的诊断价值。方法回顾性分析复旦大学附属中山医院经手术病理证实为胆管内乳头状肿瘤的14例患者的临床资料，术前均行MRI检查，成像序列包括常规T1WI、T2WI脂肪抑制、FLASH平扫和三期动态增强检查、磁共振扩散加权成像（DWI）及磁共振胰胆管造影（MRCP）检查，分析其MRI影像学表现。结果14例胆管内乳头状肿瘤中，病变区域位于肝左叶者7例，左、右叶均受累2例，肝门部2例，胆总管2例，肝右叶及胆总管均受累者1例。可见胆管内肿瘤组织12例，呈乳头状11例，呈扁平状1例，未见明显肿瘤组织2例。肿瘤组织T1WI呈低信号，T2WI呈稍高信号，动脉期轻度强化11例，中度强化1例，门脉期及延迟期均呈轻度延迟强化。14例患者病变区域DWI均呈高信号，肿瘤区域的表观弥散系数（ADC）值（1．697×10^-3mm^2／s）低于正常胆汁的ADC值（3．973×10^-3mm^2／s），差异有统计学意义（P〈0．05）。12例患者MRCP薄层图像上可见肿瘤组织形成的充盈缺损。MRCP图像可见胆道弥漫性胆管扩张，肿瘤区域明显7例、动脉瘤样扩张3例，肿瘤区域叶或段的胆管扩张4例（包括未见明显肿瘤组织2例）；其中3例胆管动脉瘤样扩张的患者经MRCP多方位重建能清晰显示肿瘤与胆道连接。14例患者均可见梗阻近端胆管扩张（且扩张程度均〉100％），同时合并梗阻远端胆管扩张9例。6例合并结石的患者中，结石位于病变区域4例，结石距病变区域较远2例。未见邻近脏器侵犯、未见远处脏器和淋巴结转移。结论胆管内乳头状肿瘤有其特征性的MRI影像学表现，MRI对胆管内乳头状肿瘤的诊断具有重要意义。Objective To analyze the value of MR imaging in diagnosis of intraductal papillary neoplasm of the bile duct （IPN-B）. Methods Fourteen patients with intraduetal papillary neoplasms of the bile duet confirmed by surgical pathology were included in this study. The patients underwent MR routine plain scanning and enhancement scanning （including T1WI, T2WI with fat suppression, FALSH T1WI, and three-phase enhancement scanning ）, diffusion weighted imaging （DWI） and magnetic resonance cholangiopancreatography （MRCP） before operation. The imaging data were reviewed and analyzed retrospectively in comparison with the surgical and pathological results. Results In these patients, 7 cases had tumors located in the left lobe, 2 cases had tumors in both the left and right lobes, 2 cases in the hepatic hilum, 2 cases in the common bile duct, and 1 case in both the right lobe and the common bile duct. Solitary or multiple intraductal masses could be found in 12 cases, with 11 cases appeared as papillary masses and one case as flat mass. In the other two cases the tumor was not visible （one case had too many stones, and in another case the tumor was too small）. The tumors in the 12 cases showed hypointensity on T1WI and hyperintensity on T2WI. On the dynamic contrast-enhanced MRI, 11 cases showed mild and one showed moderate enhancement in arterial phase, and all the cases showed mildly and gradually delayed enhancement. On DWI, the lesion areas showed high signal intensity in all the cases, and the ADC value of the tumor area （1. 697×10^-3 mm^2/s） was significantly lower than that of the normal bile （3. 973×10^-3 mm^2/s） （t = - 10.94, P 〈 0.05 ）. Twelve cases demonstrated filling defects on primary MRCP coronary thin section images. On 3D-reconstruction MRCP images, 7 eases exhibited diffuse bile duct dilatation with the tumor areas more prominent, 3 cases exhibited aneurysmal bile dilatation, while the rest 4 cases exhibited segmental or lobar bile duct dilatation （ including 2 with invis

关 键 词：胆管肿瘤 乳头状瘤 磁共振成像 诊断显像 病理学 

分 类 号：R735.8[医药卫生—肿瘤]