肿块型肝内胆管细胞癌与肝脓肿的CT特征及鉴别诊断  

CT characteristics and differential diagnosis of mass-forming intrahepatic cholangiocarcinoma and liver abscess

作　　者：王爱华[1] WANG Aihua(Department of Radiology ,the People＇s Hospital of Dezhou ,Dezhou 253014,China)

机构地区：[1]德州市人民医院放射科,山东德州253014

出　　处：《实用放射学杂志》2016年第10期1549-1551,1555,共4页Journal of Practical Radiology

摘　　要：目的：探讨肿块型肝内胆管细胞癌（ICC）和肝脓肿的 CT 表现及误诊原因分析,减少误诊率。方法回顾分析经临床手术、穿刺病理证实的肿块型 ICC 21例和肝脓肿20例影像资料,其中10例肿块型 ICC 术前影像误诊为肝脓肿,41例均行 CT 平扫和三期增强扫描。结果边缘强化环不规则、延迟不规则斑片状或片絮状强化、动脉血管穿行或环绕病灶、肝被膜凹陷征、合并肝内胆管软组织结节、肝内胆管扩张、肝门区和腹膜后淋巴结肿大、门静脉受侵狭窄或闭塞提示肿块型 ICC 可能性大。形态规则、环壁光滑完整、环壁周围环状水肿征、延迟分隔状或多环状强化、肿块缩小征、环内低密度类似液性提示肝脓肿可能性大。异常灌注肝脓肿出现几率高且明显。结论肿块型 ICC 与肝脓肿的影像特征有相似之处,又有各自的特征性表现,结合多个征象综合分析有利于正确诊断。Objective To analyze the CT characteristics and misdiagnosis reasons in mass-forming intrahepatic cholangiocarcinoma（ICC）and liver abscess to reduce the misdiagnosis rate.Methods CT features of 21 patients with mass-forming ICC and 20 patients with liver abscess proved by operation or puncture pathology were analyzed,in which 10 cases of mass-forming ICC were misdiagnosed as liver abscess.CT plain scan and three period enhanced scan were performed in 41 cases.Results Irregular edge enhancement rings,irregular patch or flocculent strengthened in delayed phase,arterial through surrounded lesions,liver capsule shrinkage,tissue nodule in intrahepatic bile duct,intrahepatic bile duct dilatation,hilar and retroperitoneal lymph node enlargement,portal vein invasion stenosis or occlusion,which possibility prompted to be the diagnosis of mass-forming ICC.Regular shape,slippery and intact ring-wall,edema syndrome around the ring wall,separate and annulate enhancement in delayed phase,reduction of tumor size and similar low density liquid in ring hints prompted to be the diagnosis of liver abscess.Liver abscess appears abnormal perfusion likely and significant.Conclusion Mass-forming ICC sharing similar imaging characteristics with liver abscess,having characteristic CT features.A comprehensive analysis of multiple signs may be helpful to arrive at a correct diagnosis.

关 键 词：胆管细胞癌 肝脓肿 计算机体层成像 磁共振成像 

分 类 号：R735.8[医药卫生—肿瘤] R575.4[医药卫生—临床医学]