肝内周围型胆管细胞癌CT和MRI诊断及病理基础研究

目的研究肝内周围型胆管细胞癌(IHPCC)的CT、MRI诊断及其病理基础。方法回顾性分析经病理证实的IHPCC病人32例,29例行CT平扫和增强扫描,5例做了MRI检查,2例行MRI动态增强扫描。结果病灶位于肝左叶24例(75%),位于右叶8例(25%)。影像上病灶呈肿块型18例、浸润狭窄型7例、腔内生长型4例,有3例未见明确肿块。病灶多数呈类圆形、不规则分叶形,增强早期强化不明显或周边强化,延迟后内部呈片状、分隔状甚至均匀性强化。病理学上见肿瘤主要由肿瘤细胞、纤维组织和凝固坏死成分组成,在肿瘤外周以存活的肿瘤细胞为主,形成早期边缘强化,而肿瘤中央以纤维成分为主,是产生延迟强化的病理基础。结论动态增强扫描是诊断IHPCC的关键技术,早期边缘强化、延迟后内部强化是其特征性影像表现。

The Diagnosis of Intrahepatic Peripheral Cholangiocarcinoma by CT and MRI Correlated with Pathological Findings Study

Objective To study the characteristics of imaging features of intrahepatic peripheral cholangiocarcinoma(IHPCC) on the CT,MRI and correlate these features with histo pathologic findings.Methods Thirty-two patients with pathologically proven IHPCC were reviewed retrospectively.The twenty-nine patients were performed CT scanning and dynamic enhancement.MR imaging were obtained in five patients,and dynamic contrast-enhanced T1-weighted imaging was performed in 2 cases.Results The location of lesions was 24 lesions(75%) in lift lobe and 8 lesions(25%) in right lobe.According to pathological type,the imaging type of tumors were mass-type 18 cases,infiltrative-type 7 cases and intracavitary-type 4 cases.In three patients the tumors were not definable at any imaging phase.The shape of tumor was circular,lobulated,irregular.and margins were clouding.No contrast or rimelike contrast enhancement with mild or moderate were the most frequent enhancement pattern observed in early stage.On the delay scan imaging,the central of tumor was showed mottling,reticular or homogeneous hyperattenuating delayed contrast enhancement.The tumor was consisted of fibrous tissue,tumor cells and coagulative necrosis at the findings of histopathologic analysis.The content of these portion was difference in different positions of tumor.At the edge of tumor,the main components was living tumor cell that was the pathological base of early contrast enhancement.The delay contrast enhancement tended to be fibrosis,that mainly situated in the tumor central,because the contrast material entrance fibrosis was very slowly but stagnated in it for long time.Conclusions Dynamic contrast enhancement scan was very important techniques for the correctly diagnosis of IHPCC.It is a typical feature of IHPCC that hypodensity of hepatic lesion on precontrast scan imaging,peripheral enhancement in the early stage and tumor central delayed contrast enhancement on the dynamic contrast enhancement scan.