胆管癌的磁共振诊断与误漏诊原因分析

目的总结胆管癌MR征像,提高MR对胆管癌的诊断与鉴别诊断的准确性。方法本组收集1996年1月～2005年12月,经MRI及MRC诊断为胆管癌或MRI诊断胆管炎但临床怀疑胆管癌67例。分析MRI和MRCP的影像学表现和诊断,并与手术病理结果进行对照。结果术前MR诊断正确的56例,漏诊8例,误诊3例。肝门区胆管癌31例;胆总管区胆管癌24例。病理学表现为结节型18例,肿块型21例,浸润型13例,乳头型14例。结论胆管癌的MRI表现与生长方式有关,MRCP诊断胆管梗阻定位准确率高,仔细观察各种征像并结合临床,可提高胆管癌诊断的准确性。

The diagnosis of cholangiocarcinoma by MR imaging and the analysis of misdiagnosis and missed diagnosis

Objective To summarize the MR imaging features of cholangiocarcinoma and to improve the accuracy of diagnosis and differential diagnosis.Methods From January 1996 to December 2005,67 patients with the diagnosis of cholangiocarcinoma or cholangitis on preoperative MRI and MR cholangiography but suspected cholangiocarcinoma clinically were collected.The diagnosis and imaging findings of these patients were analyzed and compared with the surgical and pathological findings.Results According to the preoperative MRI,the diagnosis was correct in 56 patients,missed diagnosis in 8 patients,and misdiagnosis in 3 patients.The cholangicarcinoma of hepatic hilar region and the common bile duct region was found in 31 and 24 patients respectively.Pathological manifestations were 18 cases of nodular type,21 cases of lump type,13 cases of infiltrative type,14 cases of papillary type.Conclusion The appearances of cholangiocarcinoma on MRI were correlated with the growth patterns of tumor.MRCP have a higher accuracy for localization of biliary obstruction.If meticulous observation on MRI signs and combined with clinical manifestation,it can improve the diagnostic accuracy of cholangiocarcinoma.