肝外胆管腺瘤及腺瘤局部恶变的影像学特点  

Imaging Findings of Extrahepatic Bile Duct Adenoma and the Local Malignant Transformation of Adenoma

作　　者：陈雅乐 黄梦月 刘静静[1] 程敬亮[1] 高雪梅[1] CHEN Yale;HUANG Mengyue;LIU Jingjing;CHENG Jingliang;GAO Xuemei(Department of Magnetic Resonance,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院磁共振科,河南郑州450052

出　　处：《河南医学研究》2022年第10期1794-1798,共5页Henan Medical Research

摘　　要：目的探讨肝外胆管腺瘤及腺瘤局部恶变的影像学表现,以提高诊断水平。方法回顾性分析郑州大学第一附属医院2013年3月至2021年10月23例经病理证实的肝外胆管腺瘤患者的电子计算机体层摄影技术(CT)和(或)磁共振成像(MRI)影像学资料。根据病理学结果分为腺瘤组(12例)和腺瘤局部恶变组(简称局部恶变组,11例)。对两组病变的常规影像表现及表观扩散系数(ADC)值进行对比分析。结果腺瘤组与局部恶变组的发病部位(胆总管远端或肝外胆管其他部位)、病变可测量长径[腺瘤组(18.61±11.72)mm,局部恶变组(29.70±28.88)mm]、生长方式(偏心性或胆管内铸型)、信号特点[等或稍长T_(1)、稍长T_(2)信号、DWI(b=800s·mm^(-2))高或稍高信号]、裂隙样改变(稍长T_(2)信号背景下条状更长T_(2)信号)、强化程度(轻中度强化)、强化方式(渐进性或持续性强化)、胆管扩张情况(病变处及其上方胆管扩张)在两组间差异无统计学意义(P>0.05)。局部恶变组:稍长T_(1)病变内伴有斑点状短T_(1)信号3例(提示出血)、囊变坏死1例、病变基底部胆管壁局限性增厚4例、胆囊侵犯1例。结论肝外胆管腺瘤多发生于胆总管远端,多呈偏心性肿块或局部呈胆管内铸型改变,CT呈等密度肿块,MRI多呈等或稍长T_(1)稍长T_(2)信号,可伴裂隙样改变,DWI(b=800s·mm^(-2))多呈高或稍高信号,多伴病变区及上方胆管扩张,多呈轻中度渐进性或持续性强化。腺瘤局部恶变率较高,当病变累及胆管肌层或出现囊变出血时,影像学有一定提示作用。Objective To investigate the imaging findings of extrahepatic bile duct adenoma and the local malignant change in order to improve the diagnostic level.Methods The data of 23 patients with extrahepatic bile duct adenoma confirmed by pathology were collected in the First Affiliated Hospital of Zhengzhou University from March 2013 to October 2021,the computed tomography(CT)and magnetic resonance imaging(MRI)data of all patients were analyzed retrospectively.According to the pathological results,they were divided into the adenoma group(12 cases)and adenoma local malignancy group(local malignancy group,11 cases).The conventional imaging manifestations and apparent diffusion coefficient(ADC)values of the two groups were compared and analyzed.Results Imaging findings of the adenoma group and the local malignancy group:the lesions were located at the distal end of the common bile duct or other parts of the extrahepatic bile duct,the maximum diameter of measurable lesions[adenoma group(18.61±11.72)mm,local malignancy group(29.70±28.88)mm],showed eccentric mass or local intraductal casting of bile duct,showed equal or slightly long T_(1) signal and slightly long T_(2) signal,showed high or slightly high signal on DWI(b=800 s·mm^(-2)),showed strip longer T_(2) signal in slightly long T_(2) signal background(fissure change),had mild to moderate enhancement,had progressive or continuous reinforcement,had dilatation of bile duct at and above the lesion.There was no statistically significant difference in the above imaging signs between the two groups(P>0.05).In the local malignancy group,3 cases showed spotted short T_(1) signal in slightly long T_(1) lesions(prompting bleeding),1 case showed cystic necrosis,4 cases showed local thickening of the base of the bile duct wall and 1 case showed gallbladder invasion.Conclusion Extrahepatic bile duct adenoma mostly occur at the distal end of the common bile duct,and they are mostly eccentric mass or local intraductal casting of bile duct and soft tissue density mass on CT with e

关 键 词：肝外胆管 腺瘤 电子计算机体层摄影技术 磁共振成像 

分 类 号：R445.2[医药卫生—影像医学与核医学]