肝胆管囊腺瘤及囊腺癌的CT、MRI诊断

目的总结肝胆管囊腺瘤和囊腺癌的CT、MRI表现,探讨CT、MRI诊断该肿瘤的价值。方法回顾性分析经手术病理证实为肝胆管囊腺瘤(3例)和囊腺癌(5例)的CT和(或)MRI表现、术前诊断,并与病理所见进行对照分析。结果3例囊腺瘤均为单房或多房的囊性肿物,无壁结节,术前均误诊为肝包虫或肝囊肿;5例恶性者中囊腺癌3例,囊腺瘤伴局部癌变2例。5例均为单房或多房的囊实性肿物,有壁结节。CT扫描囊性部分呈均匀液性密度,囊壁、分隔厚薄不均,壁结节大小不一,增强扫描囊壁、分隔及壁结节强化。MR示囊性部分呈均匀液性信号,增强扫描囊壁、分隔及壁结节强化。5例恶性者术前4例诊断为囊腺瘤或囊腺癌,1例诊为胆管癌。CT、MRI表现与病理所见对应良好。结论胆管囊腺癌在CT、MRI上具有特征性表现,可以做到术前正确诊断;但胆管囊腺瘤如果无壁结节则缺乏特征性表现,需要和肝复杂性囊肿或肝包虫病等鉴别。

Diagnosis of hepatobiliary cystadenoma and cystadenocarcinoma with CT and MRI

Objective To summarize the CT and MRI findings of hepatobiliary cystadenoma and cystadenocarcinoma and determine tbeir value for diagnosis of the 2 diseases. Methods Three cases of cystadenoma and 5 cases of cystadenocareinoma were diagnosed by CT and MRI and confirmed by op eration and pathology. Plain and enhanced CT scanning, plain and multiphase enhanced MRI and CT in combination with MRI were performed in 3, 3 and 2 cases, respectively. The CT and MRI features of the 8 eases were retrospectively analyzed and their correlation to pathological findings determined. Results Histological evidence showed that there were 3 cases of cystadenoma, 2 of cystadenoma with focal canceration and 3 of cystadenocarcinoma. All the 3 eases of cystadenoma were solitary cystic le sion without mural nodule. The 2 cases of cystadenoma with focal canceration and 3 of cystadenocarei noma were unilocular or multilocular cystic lesions with multiple mural nodules. One case of cystade noma with focal canceration was multiple. Mural nodules and irregular thickening of cystic walls were found in all the malignant cases. The cystic part of the lesions in all the 8 cases were of homogenous low-attenuation or low-signal intensity on T1WI and high signal intensity on T2WI. In enhanced CT or MRI. the mural nodules and cyst wall and/or septa were enhanced. Conclusion CT and MRI can be used to reveal the features of cystadenocarcinoma. Therefore. accurate preoperative diagnosis of cystadenocarcinoma can be made. However, the benign eystadenoma without mural nodule lacks char acteristic CT and MRI finds, thus it is easy to be misdiagnosed as hepatic cyst or hydatid cyst.