肝细胞癌合并胆管癌栓的CT表现及临床应用价值

目的分析肝细胞癌（HCC）合并胆管癌栓的CT表现,以期提高对HCC合并胆管癌栓的影像诊断水平。 方法收集2012年1月至2018年9月中山大学附属第一医院和江门市新会中医院26例HCC合并胆管癌栓患者资料,病例均经手术后病理证实,并行64排螺旋CT平扫及双期（动脉期和门静脉期）增强扫描。回顾性分析其CT表现,包括受累胆管的位置、胆管内癌栓的密度、强化方式、肝内肿块与胆管癌栓的关系、胆管壁的情况。以手术及病理结果为"金标准",分析CT对HCC合并胆管癌栓定位及定性的准确性。 结果26例均明确诊断为肝内肿块及胆管内肿块,HCC和胆管癌栓在CT上均清楚显示。原发HCC的CT增强扫描表现为三种强化方式："快进快退"18例（69.2%）,"快进慢退"4例（15.4%）,"三低"4例（15.4%）;胆管癌栓CT表现为扩张的胆管内填充有软组织块影,胆管远端扩张,胆管壁无增厚。24例（92.3%）HCC与癌栓相连,2例（7.7%）HCC与胆管癌栓不相连。增强扫描25例（96.2%）癌栓强化方式与肝内肿瘤的强化方式一致,1例（3.8%）强化方式不一致。CT对HCC合并胆管癌栓的检出例数、成像位置与手术及病理结果基本一致,准确性为100.0%（26/26）。 结论HCC合并胆管癌栓的CT表现具有一定的特征性,仔细分析肝内肿块及胆管内癌栓的CT表现,有助于疾病诊断。

CT findings and clinical application of hepatocellular carcinoma with bile duct tumor thrombus

ObjectiveTo analyze the CT findings of hepatocellular carcinoma (HCC) with bile duct tumor thrombus (BDTT). MethodsFrom January 2012 to September 2018, twenty-six cases of HCC with BDTT were collected from the First Affiliated Hospital of Sun Yat-sen University and Xinhui Traditional Chinese Medicine Hospital. All cases were confirmed by pathology after operation, 64-slice spiral CT plain scan and dual-phase enhanced scan (arterial phase and portal phase) were performed. The imaging features, including distribution, density and enhancement patterns of HCC and BDTT, relationship of HCC with BDTT and situation of the bile duct wall, were retrospectively analyzed. Based on the results of operation and pathology as "golden standard", the accuracy of CT in localization and qualitative analysis of HCC with BDTT was analyzed. ResultsAll the 26 cases were diagnosed as intrahepatic and intraductal masses, HCC and BDTT clearly displayed on CT. On contrast-enhanced CT images, HCC with BDTT showed three types of enhancement pattern: fast in and fast out (18 cases, 69.2%), fast in and slow out (4 cases, 15.4%), and all low density (4 cases, 15.4%). BDTT showed dilated bile ducts filled and soft tissue masses, with distal bile duct dilation, without bile duct wall thickening. HCC was directly associated with BDTT in 24 cases (92.3%), but not associated in 2 cases (7.7%). The enhancement type of BDTT was similar with HCC lesion in 25 cases (96.2%), but different in 1 case (3.8%). The accuracy of CT in detecting HCC with BDTT was 100.0% (26/26). ConclusionThe CT imaging of HCC with BDTT has certain characteristics, which is helpful for the diagnosis of the disease.