高场MRI诊断周围型肝内胆管细胞癌

目的探讨高场MRI对周围型肝内胆管细胞癌(IHPCC)的诊断和鉴别诊断价值。方法对18例经病理证实的IHPCC的MR资料进行回顾性分析。所有患者均接受MR平扫及多期增强扫描。观察MR平扫和各期强化特点,测量病灶和正常肝实质的ADC值。结果所有病灶T2WI主体均呈不均匀高或稍高信号,其中11例中心可见斑片状或星芒状低或略低信号。12例病灶动脉期呈环状强化,门静脉期及延迟期强化范围向中心扩展;3例动脉期周边及中心均不规则强化,门静脉期及延迟期强化范围扩大;1例动脉期未见强化,门静脉期边缘强化,延迟期中心强化;2例动脉期和门静脉期呈环状强化,延迟期中心未见强化。DWI病灶均呈不均匀高或稍高信号。病变区和正常肝实质ADC值为(1.42±0.13)×10-3mm2/s、(1.26±0.08)×10-3mm2/s(P<0.05)。结论高场MRI的T2WI、DWI、ADC值及多期增强扫描相结合对IHPCC的诊断具有重要价值。

High field MRI in diagnosing intrahepatic peripheral cholangiocarcinoma

Objective To investigate the value of high field MRI in diagnosing and differential diagnosing intrahepatic peripheral cholangiocarcinoma (IHPCC). Methods MRI findings of 18 patients with IHPCC proved with pathology were analyzed retrospectively. Both plain and dynamic enhanced MRI were performed in all patients. ADC value was measured in lesions and normal liver substance. Results All lesions showed mixed hyperintensity at main body on T2WI, and low signals at centre area were found in 11 patients. Twelve patients exhibited circular enhancement in arterial phase and extended enhancement scope to center in portal and delayed phase. Irregular peripheral and central enhancement in arterial phase were observed in 3 lesions, in portal and delayed phase the enhancement expanded. In 1 patient, no arterial phase enhancement of the lesion was observed, but peripheral and center enhancement occurred in portal phase and delayed phase, respectively. Circular enhancement in arterial and portal phase was noticed in 2 cases, but no central enhancement in delayed phase. On DWI, all lesions were nonuniform hyperintensity. ADC value of lesions and normal liver substance was (1.42±0.13)×10^-3 mm²/s and (1.26±0.08)×10^-3 mm²/s, respectively (P<0.05). Conclusion Confederate application of T2WI, DWI, ADC value and dynamic enhanced MRI scanning have important role in diagnosing IHPCC.