多模态MRI在不典型肝脓肿、肝脏转移瘤和肿块型胆管细胞癌中的应用和鉴别诊断  

Application and differential diagnosis of multimodal MRI in atypical liver abscess,liver metastasis and massive cholangiocarcinoma

作　　者：张盼盼[1] 陈斐[1] 王少青 曹新山[2] ZHANG Panpan;CHEN Fei;WANG Shaoqing;CAO Xinshan(Department of Radiology,Binzhou people's Hospital,Binzhou 256600,China;Department of Radiology,Binzhou Medical University Hospital,Binzhou 256600,China)

机构地区：[1]山东省滨州市人民医院放射科,山东滨州256600 [2]滨州医学院附属医院放射科,山东滨州256600

出　　处：《医学影像学杂志》2023年第6期1035-1039,共5页Journal of Medical Imaging

摘　　要：目的探讨磁共振增强成像联合扩散加权成像在不典型肝脓肿、肝脏转移瘤和肿块型胆管细胞癌中诊断价值。方法选取不典型肝脓肿(AHA)、肝脏转移瘤(LM)、肿块型胆管细胞癌(IMCC)共38例患者(58个病灶)临床及影像学资料,其中AHA组12例(19个病灶)、LM组11例(24个病灶)、IMCC组15例(15个病灶),所有病例均行DWI序列、增强扫描检查,并由病理学或临床随访证实。对三组病变的强化方式(边缘持续强化、向中心填充强化)、强化形态(类环形、分叶状、簇形)、辅助征象(肝内胆管扩张、肝包膜凹陷、周围一过性肝灌注异常)、扩散受限方式(病变中心扩散受限、病变周边扩散受限)进行分析比较。结果AHA组、LM组、IMCC组在强化方式、强化形态、伴发的辅助征象、DWI扩散受限的方式比较差异有统计学意义(P<0.001);IMCC组表现为向中心填充强化、肝内胆管扩张、肝包膜凹陷征象,分别与LM组、AHA组比较差异有统计学意义;AHA组表现为病变中心扩散受限,分别与IMCC组、LM组比较差异有统计学意义;LM组表现为类环形强化,分别与IMCC组、AHA组比较差异有统计学意义。LM组与AHA组在边缘持续强化、肝内胆管扩张、肝包膜凹陷征象差异无统计学意义;LM组与IMCC组在病变周边扩散受限差异无统计学意义;IMCC组、AHA在分叶状强化、簇形强化表现差异无统计学意义。结论多模态MRI成像在诊断不典型肝脓肿、肝脏转移瘤和肿块型胆管细胞癌的定性方面有明显价值,值得在日常工作中推广。Objective To investigate the diagnostic value of contrast-enhanced MRI(CE-MRI)combined with diffusion weighted imaging(DWI)in atypical liver abscess,liver metastasis and mass cholangiocarcinoma.Methods Clinical and imaging data of 38 patients(58 lesions)with atypical liver abscess(AHA),liver metastases(LM),and mass bile duct cell carcinoma(IMCC)were selected,including 12 cases(19 lesions)in the AHA group,11 cases in the LM group(24 lesions),and 15 cases in the IMCC group(15 lesions).All cases underwent diffusion weighted imaging sequence and contrast-enhanced magnetic resonance examination,and were confirmed by pathology or clinical follow-up.They were divided into three groups,i.e.,IMCC,LM,AHA group.The enhancement methods for the three groups of lesions(continuous enhancement at the edges and enhancement towards the center)and enhancement morphology(Ring-like,lobulated,clustered),auxiliary signs(dilatation of intrahepatic bile ducts,retraction of liver capsule,abnormal peripheral liver perfusion),and diffusion restriction on DWI(diffusion restriction in the center of the lesion,peripheral lesions diffusion restriction)were analyzed and compared in this work.Results In AHA group,LM group and IMCC group,there were statistically significant differences in enhancement mode,enhancement form,accompanying auxiliary signs and diffusion restriction on DWI(P<0.001).The IMCC group showed signs of center filling enhancement,intrahepatic bile duct dilation and hepatic capsule gyrations,which were statistically different from those of LM group and AHA group,respectively.The AHA group showed diffusion restriction in the lesion center,which was statistically different from IMCC group and LM group.The LM group presented ring-like enhancement,which was statistically different from the IMCC group and the AHA group.There were no significant differences in the signs of continuous marginal enhancement,intrahepatic bile duct dilation and hepatic capsule gyrationsn between LM group and AHA group.There was no statistical difference bet

关 键 词：磁共振成像 不典型肝脓肿 肝脏转移瘤 肝内胆管细胞癌 

分 类 号：R735.7[医药卫生—肿瘤] R445.2[医药卫生—临床医学]