肝内胆管细胞癌的影像学诊断

目的探讨肝内胆管细胞癌(ICC)的CT及MRI表现及病理基础。方法回顾性分析经手术及病理证实的肝内胆管细胞癌24例。所有病例均行B超检查,17例行CT平扫和增强扫描,14例行MRI平扫和增强扫描。结果 CT平扫病灶均为低密度,边界不清,MRI表现为T1WI低信号,T2WI呈较高信号伴中心低信号,动态CT及MRI检查病灶多表现为渐进性的向心性强化,病灶局部肝包膜可有回缩,周围肝内胆管可有轻度扩张和结石;病理表现镜下为低分化或未分化腺癌,血管分布稀少,癌巢之间为大量纤维结缔组织。CT早期强化17.6%(3/17),延迟强化82.3%(14/17),MRI检查14例T1WI低信号T2WI略高信号,边界不清,形态不规则,远端胆管迂曲扩张。MRI增强通常表现为早期轻度或中度不全边缘强化,晚期进行性同心性强化,在延迟期中心区通常为不完全强化。结论肝内胆管细胞癌CT多期增强扫描及MR动态增强扫描均具有一定的特异性,对于肝内与其它常见病变的鉴别诊断均有重要价值.

Imaging Diagnosis of Intrahepatic Cholangiocarcinoma

Objective To investigate the CT and MRI image characteristics and the basis of pathology of intrahepatic cholangiocarcinoma.Methods Retrospective analysis confirmed by surgery and pathology of intrahepatic cholangiocarcinoma in 24 patients.All patients underwent ultrasonography B,and 17 cases routine CT scan and enhanced scan,14 routine MRI examination.Results At CT,lesions of 3 cases（3/17） were earlier enhanced in the arterial phase,but lesions of 14 cases（14/17） were later enhanced in portal venous phase.MRI showed hypointensity on T1-weighted images（T1WI） and slight hyperintensity on T2-weight images（T2WI） in 14 cases,hyporintensity on either T1WI or T2WI in the others.In addition,＂sign of bile lake＂ and dilated bile duct adjacent to lesion.Conclusion Intrahepatic cholangiocarcinoma multi-phase enhanced CT scan and dynamic contrast-enhanced MR scanning has a specificity both for the liver and other common diseases have significant value in differential diagnosis.