不典型肝内胆管细胞癌合并脓肿的影像学诊断要点

目的 探讨不典型肝内胆管细胞癌合并肝脓肿的影像表现特征和诊断要点。方法? 回顾性分析1例经手术病理证实为肝内胆管细胞癌合并肝脓肿病人的临床资料、影像表现特征并复习相关文献。结果? MDCT平扫显示巨大不规则肿物，累及肝左叶及部分右前叶，肿物呈分叶状，内部密度不均，邻近血管无受侵、肝包膜无凹陷征；增强CT检查动脉期显示肿物呈多结节融合状，病灶边缘及内部各结节呈明显环形强化，门静脉期及平衡期肿物强化仍较明显。肝脏MRI平扫肿物呈不规则形稍长T1、稍长T2信号影，于DWI序列上显示不均匀较明显高信号，增强扫描表现类似于增强CT表现，另于MRI增强扫描门静脉期及平衡期可见肿物内局部区域呈分房状表现，增强程度更明显。结论? 不典型肝内胆管细胞癌合并肝脓肿兼具两种病变的影像表现。正确诊断需结合临床、实验室检查、超声表现并注重影像表现的细节信息。

Imaging diagnostic essential of atypical intrahepatic cholangiocellular carcinoma accompanied by abscess

Objective To investigate the imaging features and diagnostic essential of intrahepatic cholangiocellular carcinoma accompanied by abscess. Methods The clinical data and imaging features of one case of intrahepatic cholangiocellular carcinoma accompanied by abscess were retrospectively analyzed, and literature were reviewed. Results Plain CT scan showed a huge mass which involved the left lobe and right anterior lobe of the liver with the lobulated, ill-defined boundary, inhomogenous internal density, and no vascular invasion and adjacent hepatic capsular retraction were found. Contrast enhanced CT examination of arterial phase showed a multi-nodule fusion mass, which has the evident enhanced edge of the lesion and the internal multiple nodules. The mass enhancement was still obvious on portal vein phase and equilibrium phase. Liver MRI scan showed an irregular shaped mass with slightly low signal on T 1-weighted and slightly high signal on T2-weighted images;the mass were inhomogeneous high signal intensity on the DWI. Imaging appearances of contrast enhanced MR scanning were similar to enhanced CT. A local area with loculated enhanced more significantly than the edge of the mass were found within the mass on portal vein and equilibrium phase. Conclusion The imaging features of atypical cholangiocellular carcinoma accompanied by hepatic abscess include the characteristic signs of both diseases. To obtain a correct imaging diagnosis, clinical data, laboratory examination and ultrasonography findings should be concerned and most importantly, detailed CT and MR findings should be emphasized and analyzed.