肝外胆管癌影像学诊断与手术病理对照分析

目的 通过肝外胆管癌的影像学诊断,探讨MR胆胰管造影（MRCP）对肝外胆管癌的诊断价值。地65例经手术病理证实的肝外胆管癌,其中行超声波检查（US）60例,电子计算机断层扫描（CT）52例,逆行胰胆管造影（ERCP）20例,经皮肝穿刺胆管造影（PTC）9例,磁共振胆胰管造影（MRCP）20例。根据各种检查方法显示的影像学表现和诊断,与手术病理结果进行对照分析。结果 定位诊断准确率US为81．7％,CT为84．6％,ERCP为75．0％,PTC为88．9,MRCP为100％;定性诊断准确率US为73．3％,CT为82．7％,ERCP为75．0％,PTC为88．9％,MRCP为95．0％。结论 MRCP对肝外胆管癌诊断定位和定性优于US、CT、ERCP及PTC。     

恶性胆管梗阻的MRI、MRCP诊断与临床对照研究

目的评价磁共振成像（MRI）、磁共振胰胆管成像（MRCP）对恶性胆管梗阻的诊断价值。方法84例经临床、彩色超声、螺旋CT发现的恶性胆管梗阻患者行MRI、MRCP联合检查,并与手术病理对照。结果MRI及MRCP对恶性胆管梗阻有较高的诊断准确率（95．2％,80／84）。肝内胆管扩张呈树枝状和腊肠状。低位胆管梗阻的胆总管末端呈截断状、杯口状。结论MRI、MRCP联合检查诊断恶性胆管梗阻准确率高,可以作为不宜行经内窥镜逆行胰胆管造影（ERCP）患者的替代检查方法。     

MRCP对恶性梗阻性黄疸的诊断价值

目的探讨磁共振胰胆管成像(magnetic resonance cholangiopancreatography,MRCP)对恶性梗阻性黄疸的诊断价值,提高MRCP对恶性梗阻性黄疸的诊断准确性。方法总结80例恶性病变致梗阻性黄疸的MRCP及常规MRI(磁共振成像)的影像学特征,将MRCP诊断结果与手术病理检查结果进行对照,分析MRCP诊断的准确性及各种恶性梗阻性黄疸MRCP的特征性表现。结果 MRCP对恶性梗阻性黄疸的定位诊断及梗阻近端胆管显示率为100.0%;对恶性梗阻性黄疸的的诊断准确率为83.8%,定位、定性诊断特异性高。结论 MRCP对恶性梗阻性黄疸的定位诊断准确率达100.0%;在定性诊断中有重要地鉴别诊断价值;能明显提高对恶性梗阻性黄疸的诊断准确率。     

磁共振胰胆管造影检查在肝门部胆管癌诊治中的应用

 【摘要】　目的　探讨磁共振胰胆管造影（MRCP）在肝门部胆管癌术前评估中的价值。方法　采用改良的手术标准，选择57例有潜在手术切除可能的肝门部胆管癌患者，术前进行MRCP影像学评估, 并与手术和病理对比。结果　MRCP术前定性准确率为100 %，分型准确性为93 ％（53／57）；肝管汇合部变异8例，变异率26.7 ％，有些变异对手术有利；左、右肝管增长，其中以左肝管尤其明显，这对胆肠吻合口的选择有利；术前MRCP检查显示，胆管癌病变上缘至胆管二级分支之间胆管长度＞0.5 cm或存在胆道变异的部分Ⅳ型肝门部胆管癌患者，手术切除率及根治率均明显提高，与其他3型之间差异无统计学意义。结论　MRCP可对肝门部胆管癌进行较准确的术前定性和分型；术前MRCP显示肝内二级胆管支及肝管汇合部变异对制定肝门部胆管癌，尤其是Ⅳ型肝门部胆管癌的外科手术方案有重要意义，不仅能提高切除率和根治率，而且有利于选择合适的胆肠吻合方式，可避免术中胆道误损伤。     

胆管癌的磁共振成像表现及其临床意义

目的：通过磁共振成像(MR)征象与手术对照分析，探讨胆管癌的MR特点。方法：27例患行常规轴位SE，12加权成像和呼吸门控FSE，12加权成像，并做冠状位：MRCP成像，所有患经手术和病理证实，分析病灶信号特征、形态、范围，并与术中所见进行比较。结果：16例肝门型胆管癌在磁共振成像上多呈放射状(89％)，术中所见病灶沿胆管浸润生长，且病灶范围比MRI所见大。所有胆管癌病灶在TIWI上均呈低信号(100％)，4例肝内胆管癌在T2WI上为混杂信号，11例肝门型胆管癌在，T2WI上呈等(61％)或稍高信号(39％)，2例壶腹癌在T2WI上呈低信号。在MRCP上所有病人表现为胆道梗阻。16例(89％)：MRCP分型与临床分型一致。结论：胆管癌在磁共振成像上有较特征性表现，且能提供病变准确部位，但对病变范围估计不足，MRCP用于肝门型胆管癌临床分型是可行的。     

肝内胆管结石合并胆管癌的影像诊断与临床病理对照

[目的]探讨肝内胆管结石合并肝内胆管癌影像表现与临床病理关系。[方法]回顾分析经手术病理证实的肝内胆管结石合并肝内胆管癌18例。18例行CT平扫和多期增强扫描。13例行MRI平扫和多期增强。[结果]肝内胆管不同程度扩张,并含结石影,肝内肿块形态不规则、境界不清,其内部密度(信号)不均且差异大。多期增强扫描显示,动脉期周边轻度强化,延时期扫描肿块不均匀强化,持续时间较长。病理成分不同、比例分布不同是不同影像表现的病理基础。[结论]肝内胆管结石合并肝内胆管癌临床表现复杂。多期增强扫描是CT、MRI诊断要点。     

胆管内乳头状肿瘤磁共振成像的诊断价值

目的 探讨胆管内乳头状肿瘤磁共振成像(MRI)的诊断价值.方法 回顾性分析复旦大学附属中山医院经手术病理证实为胆管内乳头状肿瘤的14例患者的临床资料,术前均行MRI检查,成像序列包括常规T1 WI、T2WI脂肪抑制、FLASH平扫和三期动态增强检查、磁共振扩散加权成像(DWI)及磁共振胰胆管造影(MRCP)检查,分析其MRI影像学表现.结果 14例胆管内乳头状肿瘤中,病变区域位于肝左叶者7例,左、右叶均受累2例,肝门部2例,胆总管2例,肝右叶及胆总管均受累者1例.可见胆管内肿瘤组织12例,呈乳头状11例,呈扁平状1例,未见明显肿瘤组织2例.肿瘤组织TIWI呈低信号,T2WI呈稍高信号,动脉期轻度强化11例,中度强化1例,门脉期及延迟期均呈轻度延迟强化.14例患者病变区域DWI均呈高信号,肿瘤区域的表观弥散系数(ADC)值(1.697×10-3 mm2/s)低于正常胆汁的ADC值(3.973×10.mm2/s),差异有统计学意义(P＜0.05).12例患者MRCP薄层图像上可见肿瘤组织形成的充盈缺损.MRCP图像可见胆道弥漫性胆管扩张,肿瘤区域明显7例、动脉瘤样扩张3例,肿瘤区域叶或段的胆管扩张4例(包括未见明显肿瘤组织2例);其中3例胆管动脉瘤样扩张的患者经MRCP多方位重建能清晰显示肿瘤与胆道连接.14例患者均可见梗阻近端胆管扩张(且扩张程度均＞ 100％),同时合并梗阻远端胆管扩张9例.6例合并结石的患者中,结石位于病变区域4例,结石距病变区域较远2例.未见邻近脏器侵犯、未见远处脏器和淋巴结转移.结论 胆管内乳头状肿瘤有其特征性的MRI影像学表现,MRI对胆管内乳头状肿瘤的诊断具有重要意义.     

MRCP及LAVA联合应用在壶腹周围癌鉴别诊断中的价值

目的：探讨磁共振胰胆管造影（MRCP）联合动态增强扫描（LAVA）对壶腹周围癌诊断的价值。方法：对48例壶腹周围癌患者进行MRI、MRCP和LAVA检查,进行诊断及鉴别诊断,并与病理结果行对比分析。结果：48例壶腹周围癌共同的MRI表现为低位胆道梗阻和连接区的软组织肿块,不同来源的肿瘤引起胆管系统的改变及强化方式有一定的差异。本组壶腹周围癌MRI诊断与手术病理结果一致者42例（87.5%）,未明确诊断者4例（8.3%）,不一致者2例（4.2%）。胆管癌及乳头区十二指肠癌诊断符合率较高, 壶腹癌及胰头癌诊断符合率略低。结论：MRI、MRCP和LAVA联合应用对壶腹周围癌的鉴别诊断及判断肿瘤周围组织浸润和转移具有重要价值,其影像学结果对临床治疗决策有指导意义。     

MRCP及LAVA联合应用在壶腹周围癌鉴别诊断中的价值

目的:探讨磁共振胰胆管造影(MRCP)联合动态增强扫描(LAVA)对壶腹周围癌诊断的价值.方法:对48例壶腹周围癌患者进行MRI、MRCP和LAVA检查,进行诊断及鉴别诊断,并与病理结果行对比分析.结果:48例壶腹周围癌共同的MRI表现为低位胆道梗阻和连接区的软组织肿块,不同来源的肿瘤引起胆管系统的改变及强化方式有一定的差异.本组壶腹周围癌MRI诊断与手术病理结果一致者42例(87.5%),未明确诊断者4例(8.3%),不一致者2例(4.2%).胆管癌及乳头区十二指肠癌诊断符合率较高,壶腹癌及胰头癌诊断符合率略低.结论:MRI、MRCP和LAVA联合应用对壶腹周围癌的鉴别诊断及判断肿瘤周围组织浸润和转移具有重要价值,其影像学结果对临床治疗决策有指导意义.     

肝门区胆管癌的MRI应用价值(英文)

目的探讨肝门区胆管癌(HC)的 MRI 检查技术及应用价值。方法 HC 34例所有病例均行 MR一体化扫描,包括 MR 平扫、MRCP、MR 动态增强血管成像(3D-DCE-MRA),并作出能否手术切除的评价,与手术结果相对照。结果 34例 HC 均可见肝门肿块、肝内胆管扩张、肝门胆管中断,动态增强扫描31例表现为延迟强化,3D-DCE-MRA中6例在动脉期表现为螺旋样动脉,18例可见门静脉受侵,表现为门脉侧壁浸润、门脉缩窄或闭塞,MRI 对能否手术切除评估的准确性为88.2%(30/34)。结论 MRI 检查能充分显示 HC 病变及其侵犯范围,对 HC 进行准确的诊断和术前评估。     

肝外胆管癌的介入治疗现状与展望

肝外胆管癌是指源于肝外胆管包括肝门区至胆总管下端胆管的恶性肿瘤.在美国癌症联合会(American Joint Committee on Cancer,AJCC)第8版指南中,肝外胆管癌被分类分为肝门胆管癌和远端胆管癌两部分.近年来,肝外胆管癌的发病率逐渐升高,且预后较差,手术切除在治疗中的局限性逐渐体现.在胆管癌的诊...     

肝外胆管癌组织MMP-2表达及其临床意义

目的 MMP-2是基质金属蛋白酶(matrixmetalloproteinase,MMPs)家族中最主要的家族成员,因其可以降解细胞外基质,使癌细胞能够顺利穿透细胞外基质和基底膜组成的屏障,浸润其临近的纤维结缔组织,进而发生远处转移.本研究探讨MMP-2在肝外胆管癌及正常胆管组织中的表达水平及其临床意义.方法 收集济宁医学院附属湖西医院2005-11-01-2010-04-30肝外胆管癌手术切除蜡块标本共61例为研究对象,选取同期胆管正常组织标本35例作为对照.采用免疫组化方法检测61例肝外胆管癌及35例胆管正常组织中MMP-2蛋白的表达情况,统计分析MMP-2蛋白和患者临床病理特征及预后相关性.结果 肝外胆管癌组中MMP-2阳性表达率73.77%(45/61),显著高于胆管正常组织的5.71%(2/35),差异有统计学意义,P<0.001.不同性别、年龄、肿瘤分化程度、淋巴结转移和TNM分期肝外胆管癌组织中MMP-2表达水平差异有统计学意义,均P值<0.05.MMP-2阴性肝外胆管癌患者术后1、3和5年生存率分别为82.00%、55.00%和25.00%,MMP-2阳性肝外胆管癌患者术后1、3和5年生存率分别为33.00%、9.00%和0,两组生存率差异有统计学意义,χ2=16.556,P<0.001.结论 MMP-2的表达与肝外胆管癌发生、发展和浸润转移相关,可能在肝外胆管癌的浸润转移中发挥重要作用.MMP-2有望成为新的肝外胆管癌的肿瘤标志物,为预后判断和制定相应的治疗方案提供依据.     

胰头癌与胰头慢性胰腺炎的MR诊断与鉴别诊断

目的探讨胰头癌及胰头慢性胰腺炎的MR诊断与鉴别诊断。方法回顾性分析24例胰头癌及3例胰头慢性胰腺炎的MR表现。全部27例病人均行常规及压脂SET1WI序列、常规及压脂FSET2WI序列扫描。8例胰头癌及3例胰头慢性炎症患者行压脂SET1WI序列增强扫描。T2WI序列发现胰管扩张时行MRCP共24例,其中胰头癌23例,慢性胰腺炎1例。结果24例胰头癌于常规SET1WI序列呈低(n=8)或稍低(n=16)信号,于常规FSET2WI序列可表现为高(n=8)、稍高(n=5)、等(n=10)或低(n=1)信号,于压脂FSET2WI序列可表现为高(n=11)、等(n=11)或稍低(n=2)信号,于压脂SET1WI序列均呈低信号。23例胰头癌于MRCP均可见典型的“双管征”、胆总管扩张及远端截断。8例胰头癌无明显强化。3例胰头慢性胰腺炎于常规SET1WI序列呈稍低或等信号,于常规FSET2WI序列均呈高信号。2例于压脂SET1WI及FSET2WI序列分别呈等信号及稍高信号,另1例则分别呈低信号及混杂信号,MRCP可见胆总管轻度扩张伴胰管近端不规则扩张。3例慢性胰炎均呈不同程度强化。结论胰头癌与胰头慢性胰腺炎均于多个序列表现出信号的多样性,均可见异常强化,绝大多数胰头癌及部分胰头慢性胰腺炎有异常的MRCP表现。联合使用多种序列特别是平扫及增强压脂SET1WI序列及MRCP,可能鉴别胰头癌与胰头慢     

Diagnostic imaging approaches and relationship to hepatobiliary cancer staging and therapy

Diagnostic imaging plays an essential role in management of hepatobiliary tumors. High resolution images provided by computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US) allow detection of tumor within the liver. CT arterial portography remains the standard for detection of small lesions in the range of 1.5 cm, but noninvasive techniques such as contrast-enhanced helical CT and MR hold promise for comparable lesion detection. MRI provides lesion characterization for differentiation of benign and malignant tumors. Lesion characterization has been further improved by faster CT and MR techniques that allow imaging in both arterial and portal venous phases for characterization of lesions based on the rate and pattern of enhancement. Functional imaging such as 2-fluoro-2-deoxy-D-glucose-positron-emission tomography (FDG-PET) is increasingly utilized for detection of intrahepatic tumor and extrahepatic disease. Accuracy of FDG-PET for extrahepatic disease is better than conventional imaging and has been shown to change management in a significant number of patients. Imaging is also invaluable for surgical planning. Segmental anatomy is well shown by CT, MRI, and US. CT or MR angiography with newer 3D techniques delineate vascular variants and areas of encasement or occlusion by tumor. Biliary involvement at the hilus may be shown by US and MR cholangiography. Imaging detection of vascular involvement, bile duct extension, and lobar atrophy may alter the surgical approach.     

Carcinoid tumors of the extrahepatic bile duct. A rare cause of malignant biliary obstruction

BACKGROUND: Carcinoid tumors of the extrahepatic bile duct are rare and account for 0.2-2% of all gastrointestinal carcinoids. Similar to other tumors of the bile duct, these lesions are difficult to diagnose preoperatively and nearly impossible to distinguish from cholangiocarcinoma. METHODS: The authors retrospectively analyzed all reported cases of carcinoid tumor of the bile duct and report on two additional cases. RESULTS: Thirty cases of carcinoid tumor of the bile duct have been reported. Among this group were 20 women and 9 men (female-to-male ratio, 2.2:1) with an overall mean age of 47 years (range, 19-79 years). The most common anatomic sites for extrahepatic carcinoid tumors were the common bile duct (58%), perihilar region (28%), cystic duct (11%), and common hepatic duct (3%). Jaundice was the most common presenting complaint (55%). Sixty-nine percent of patients with extrahepatic biliary carcinoids had disease confined to the bile duct, whereas 31% had evidence of distant metastases. All patients who presented with localized disease remain disease free with a mean follow-up of 32 months (range, 3 months to 20 years). CONCLUSIONS: Carcinoid tumor of the bile duct is a rare form of malignant biliary obstruction. Unlike cholangiocarcinoma, biliary carcinoids occur more commonly in younger patients and in women. Aggressive local invasion by the primary tumor is rare, and metastases occur in less than one-third of patients. All patients who underwent a curative surgical resection were alive and disease free at time of published report, implying a more favorable prognosis. Aggressive surgical resection is recommended.     

Evaluation of VEGF A expression and microvascular density as prognostic factors in extrahepatic cholangiocarcinoma.

OBJECTIVES: Angiogenesis is essential for tumor growth and metastasis. An association between microvessel density, a measure of tumor angiogenesis, and conventional prognostic variables has been shown for many different tumor entities. In extrahepatic cholangiocarcinoma, the VEGF expression and microvessel density have rarely been investigated. METHODS: Paraffin-embedded specimens from 51 resected adenocarcinomas of the extrahepatic bile duct were immunostained for vascular endothelial growth factor A (VEGF A) and CD 34 to evaluate the microvessel density (MVD). VEGF A staining was evaluated by combining intensity and percentage of positive tumor cells, as low (expression equal or below the median), or high (above the median). Microvessel density was assessed using a method published by Weidner et al. RESULTS: Median disease free survival (DFS) of the study group was 12.5 months (range, 1-66.3 months). DFS was calculated in the 39 patients with complete resection. It was significantly better in patients with low microvessel density than DFS in patients with high microvessel density (33 months (range, 3-66.3 months) vs. 21.8 months (range, 1.6-31.6 months); p=0.022). In contrast, VEGF A expression did not correlate with survival. There was a trend toward a higher VEGF A expression in highly vascularized tumors (p=0.08), but failed to reach statistic significance. CONCLUSIONS: The present study indicates, that vascularisation has an important impact on survival of extrahepatic cholangiocarcinoma patients. Other molecules than VEGF A are probably involved in neovascularization in extrahepatic cholangiocarcinoma.     

肝门区胆管癌的MRI应用价值

目的探讨肝门区胆管癌(HC)的MRI检查技术及应用价值。方法HC34例所有病例均行MR一体化扫描,包括MR平扫、MRCP、MR动态增强血管成像(3D-DCE-MRA),并作出能否手术切除的评价,与手术结果相对照。结果34例HC均可见肝门肿块、肝内胆管扩张、肝门胆管中断,动态增强扫描31例表现为延迟强化,3D-DCE-MRA中6例在动脉期表现为螺旋样动脉,18例可见门静脉受侵,表现为门脉侧壁浸润、门脉缩窄或闭塞,MRI对能否手术切除评估的准确性为88.2%(30/34)。结论MRI检查能充分显示HC病变及其侵犯范围,对HC进行准确的诊断和术前评估。