肝脏黏液性囊性肿瘤与囊肿型胆管内乳头状肿瘤的磁共振成像诊断和鉴别诊断  

Magnetic resonance imaging characteristics in diagnosis and differential diagnosis of hepatic mucinous cystic neoplasm and cyst-forming intraductal papillary neoplasm of the bile duct

作　　者：刘林成 李建龙[1] 陈伶俐 曾蒙苏 王明亮 Liu Lincheng;Li Jianlong;Chen Lingli;Zeng Mengsu;Wang Mingliang(Department of Radiology,People's Hospital of Rizhao,Rizhao 276800,China;Department of Pathology,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Radiology,Zhongshan Hospital,Fudan University,Shanghai 200032,China;Department of Radiology,Shanghai Geriatric Medical Center,Shanghai 201104,China)

机构地区：[1]日照市人民医院医学影像科,日照276800 [2]复旦大学附属中山医院病理科,上海200032 [3]复旦大学附属中山医院放射科,上海200032 [4]上海市老年医学中心放射科,上海201104

出　　处：《中华消化杂志》2024年第11期757-762,共6页Chinese Journal of Digestion

摘　　要：目的:分析肝脏黏液性囊性肿瘤(MCN)和囊肿型胆管内乳头状肿瘤(IPNB)的磁共振成像(MRI)特征,旨在提高临床医师对两者的诊断与鉴别诊断能力。方法:回顾性分析2010年6月1日至2023年10月20日于复旦大学附属中山医院和日照市人民医院经手术切除且经病理证实的肝脏MCN(58例,肝脏MCN组)和囊肿型IPNB(38例,囊肿型IPNB组)共96例患者的临床资料和MRI特征。临床资料包括性别、年龄等;MRI特征包括病灶有无分隔、出血、钙化等。统计学方法采用卡方检验或Fisher确切概率法。结果:肝脏MCN组的女性占比[91.4%(53/58)比60.5%(23/38)],以及病灶有分隔[89.7%(52/58)比34.2%(13/38)]、出血[31.0%(18/58)比5.3%(2/38)]、钙化[12.1%(7/58)比0(0/38)]的患者占比均高于囊肿型IPNB组,肝脏MCN组中病灶呈浸润性[10.3%(6/58)比55.3%(21/38)]、上游胆管扩张[20.7%(12/58)比89.5%(34/38)]、有壁结节[8.6%(5/58)比94.7%(36/38)]、下游胆管扩张[0(0/58)比65.8%(25/38)]、肝叶萎缩[0(0/58)比10.5%(4/38)]、与胆管相通[0(0/58)比100.0%(38/38)]的患者占比均低于囊肿型IPNB组,差异均有统计学意义(χ^(2)_(性别)=13.25、χ^(2)_(病灶分隔)=32.28、χ^(2)_(浸润性)=22.92、χ^(2)_(上游胆管扩张)=43.52,其余均采用Fisher确切概率法;均P<0.05)。结论:肝脏MCN和囊肿型IPNB的MRI影像具备一定特征与差异,MRI有助于两者的诊断与鉴别诊断。Objective:To analyze the magnetic resonance imaging(MRI)characteristics of hepatic mucinous cystic neoplasm(MCN)and cyst-forming intraductal papillary neoplasm of the bile duct(IPNB),aiming to improve physicians′ability of diagnosis and differential diagnosis of these 2 diseases.Methods:From June 1,2010 to October 20,2023 at Zhongshan Hospital,Fudan University and People′s Hospital of Rizhao,the clinical data and MRI characteristics of 96 patients with hepatic MCN(58 cases,hepatic MCN group)or cyst-forming IPNB(38 cases,cyst-forming IPNB group)who underwent surgical resection with pathological confirmation were retrospectively analyzed.The clinical data included gender,age,etc.The MRI characteristics included lesion characteristics such as septum,hemorrhage,and calcification,etc.Chi-square test or Fisher′s exact probability method was used for statistical analysis.Results:The proportion of female,the presence of septatum,hemorrhage and calcification of the hepatic MCN group were all higher than those of the cyst-forming IPNB group(91.4%(53/58)vs.60.5%(23/38),89.7%(52/58)vs.34.2%(13/38),31.0%(18/58)vs.5.3%(2/38),12.1%(7/58)vs.0(0/38));the proportion of lesions with invasion,upstream bile duct dilation,mural nodule,downstream bile duct dilation,hepatic lobe atrophy,and communicated with the bile duct of the hepatic MCN group were all lower than those of the cyst-forming IPNB group(10.3%(6/58)vs.55.3%(21/38),20.7%(12/58)vs.89.5%(34/38),8.6%(5/58)vs.94.7%(36/38),0(0/58)vs.65.8%(25/38),0(0/58)vs.10.5%(4/38),0(0/58)vs.100.0%(38/38));and the differences were statistically significant(χ^(2)_(gender)=13.25,χ^(2)_(septatum)=32.28,χ^(2)_(invasion)=22.92,χ^(2)_(upstream bile duct dilation)=43.52,others were all Fisher′s exact probability method;all P<0.05).Conclusion:The MRI characteristics of hepatic MCN and cyst-forming IPNB have certain characteristics and differences,and MRI is helpful for the diagnosis and differential diagnosis of the 2 diseases.

关 键 词：肝脏 黏液性囊性肿瘤 囊肿型胆管内乳头状肿瘤 磁共振成像 诊断 

分 类 号：R735.7[医药卫生—肿瘤]