周围型肝内胆管细胞癌CT及MRI征象分析  

Analysis on CT and MRI aigns of intrahepatic peripheral cholangiocarcinoma

作　　者：黎涛[1] 杨永青 LI Tao;YANG Yongqing(Department of Medical Imaging,Shandong Provincial Hospital Affiliated to Shandong University,Shandong,Ji'nan 250014,China;Department of Radiology,Jinan Central Hospital Affiliated to Shandong University,Shandong,Ji'nan 250013,China)

机构地区：[1]山东大学附属省立医院医学影像科,山东济南250014 [2]山东大学附属济南市中心医院放射科,山东济南250013

出　　处：《中国医药科学》2019年第17期149-151,172,共4页China Medicine And Pharmacy

摘　　要：目的围绕周围型肝内胆管细胞癌(IHPCC)的病理改变及CT与MRI征象表现展开对照并进行分析研究,以加深对此病鉴别诊断能力、有助于诊断水平的提升。方法回顾性分析70例做过CT及MR检查且已行穿刺活检或经过手术取得病理证实的病例。结果病例组70例,其中38例为肿块型、18例为管周浸润型、10例为管内生长型,4例未见明确肿块。病灶位于肝左叶50例,位于右叶20例。CT平扫显示大部分肿块密度略低,同正常肝组织间界限模糊。MRI平扫病灶信号表现为T1WI序列上呈低或稍低信号,T2WI呈稍高或欠均匀高信号;动态增强扫描:动脉期病灶强化较弱、不明显或表现为边缘强化,延迟期扫描病灶中央部位呈条隔状、混杂高低不等或者质地均一的强化,相应区域肝内胆管的扩张时常出现,肝叶萎缩经常发生,肝内胆管结石有时可并存。结论CT及MR动态增强检查早期其边缘强化、延迟后内部强化为肝内胆管细胞癌典型影像表现。同时参照其它CT、MR表现以及临床资料进行综合分析,能够排除肝内其它疾病。CT、MR表现可以提供更多的诊断相关信息,显著提高其与其他肝内肿瘤鉴别诊断能力并提高诊断信心。Objective To compare and analyze pathological changes and CT and MRI manifestations of intrahepatic peripheral cholangiocarcinoma(IHPCC)to deepen the differential diagnosis of this disease and contribute to the improvement of diagnostic level.Methods 70 patients who underwent CT and MR examinations and who had undergone biopsy or pathological confirmation were retrospectively analyzed.Results Among 70 cases,38 cases were mass type,18 cases were perivascular infiltration type,10 cases were intraductal growth type and 4 cases had no clear mass.The lesions were located in the left lobe of the liver in 50 cases and the right lobe in 20 cases.CT plain scan showed that most of the tumors had a slightly lower density and blurred boundaries with normal liver tissue.MRI plain scan showed a low or slightly low signal on T1WI sequence and a slightly higher or less uniform high signal on T2WI sequence.Dynamic contrast-enhanced scanning showed that the lesions in the arterial phase were weak,inconspicuous or marginal enhancement.In the delayed phase,the central part of the delayed scanning lesion showed striate septal with enhancement of mixed high and low inequality or uniform enhancement.The expansion of intrahepatic bile ducts often occurred in the corresponding areas,and hepatic lobe atrophy often occurred and intrahepatic bile duct stones sometimes coexisted.Conclusion The typical image of intrahepatic peripheral cholangiocarcinoma is characterized by marginal enhancement in early phase and internal enhancement in delayed phase in CT and MR dynamic enhancement examinations.At the same time,with reference to other CT,MR manifestations and clinical data for comprehensive analysis,it can exclude other diseases in the liver.CT and MR findings can provide more diagnostic-related information,significantly improve their ability to differentiate from other intrahepatic tumors and improve diagnostic confidence.

关 键 词：胆管细胞癌 病理学 X线 计算机断层扫描 磁共振成像 

分 类 号：R735.8[医药卫生—肿瘤]