CT与磁共振成像对肝内胆管细胞癌的诊断价值

目的:探讨CT与磁共振成像(MRI)对肝内胆管细胞癌(intrahepatic cholangiocarcinoma,ICC)的诊断价值。方法:经手术或活检病理证实的ICC患者29例,其中15例行多层螺旋CT平扫和动态增强扫描,16例行MRI平扫和动态增强扫描。回顾分析肿瘤的形态学特征、CT及MRI影像学表现特征以及附属征象。结果:29例ICC,共检出32个病灶,肝左、右叶均见分布。CT共检出17个病灶,平扫仅1个病灶表现为混杂密度,其余均呈低密度;增强扫描动脉期显示10个病灶呈边缘强化,6个病灶呈轻度不均匀强化,1个病灶未见强化,门脉期显示12个病灶呈渐进性强化,5个病灶强化减退。MRI共检出17个病灶,T1WI、T2WI主要表现为混杂的异常信号;动态增强扫描动脉期显示16个病灶呈边缘环形或不规则强化,1个病灶无明显强化,门脉期和延迟期显示15个病灶瘤内实性部分的信号呈渐进性增强,强化程度更加明显,1个病灶瘤体边缘保持厚环状明显强化,1个病灶强化减弱。附属征象包括胆管扩张15例,局部肝包膜凹陷2例,肝叶萎缩1例,门静脉癌栓4例。结论:ICC的CT和MRI表现具有一定的特征性,动态增强扫描是其诊断和鉴别诊断的重要方法,术前详尽的影像学检查是及早发现ICC的重要途径。

The Value of CT and Magnetic Resonance Imaging in Diagnosing Intrahepatic Cholangiocarcinoma

To study the value of CT and magnetic resonance imaging （MRI） in diagnosing intrahepatic cholangio- carcinoma （ICC）. Methods： A total of 29 cases of ICC confirmed by surgery and biopsy pathology were enrolled in this study. 15 cases of them underwent multiphase spiral CT scan without and with contrast enhancement, 16 cases （2 of them had concur rent CT scan） underwent plain and dynamic enhanced MRI examination. Tumor morphology, the imaging features of CT and MRI, as well as ancillary signs were reviewed retrospectively. Results： Of the 29 cases of ICC, totally 32 lesions were revealed, distributed in either left or right hepatic lobe. Totally 17 lesions were detected by CT. Among them, only 1 lesion showed mixed-density, the other 16 lesions showed low-density. After contrast administration,on arterial phase, 10 lesions showed pe ripheral enhancement,6 lesions showed mild heterogeneous enhancement, 1 lesion showed no enhancement; on portal venous phase period,12 lesions showed progressive enhancement and 5 lesions showed decreased enhancement. In the 16 cases under- went MRI, 17 lesions were found. All of the 17 lesions showed irregular and mixed intensity on T1 WI and T2 WI. After dynam- ic contrast enhancement, on arterial phase, 16 lesions demonstrated peripheral enhancement, only 1 lesion showed no enhance- ment; on portal venous phase and delay period, 15 lesions demonstrated progressive contrast enhancement within the solid part of the tumor and filling enhanced degree of enhancement is more obvious, 1 lesion was significantly enhanced to keep the edge of a thick ring of tumor, 1 lesion was enhancement decreased. Subsidiary signs induded biliary duct dilatation in 15 cases, capsular retraction of hepatic parenchyma in 2 cases,hepatic atrophy in 1 case,and portal vein tumor thrombus in 4 cases. Conclusions： To some extent,the CT and MRI features of ICC are characteristic. Dynamic enhancement scan is an important method for the diagnosis and differential diagnosis of ICCs. Detailed preoperative imaging is important for the early detection of ICC.