肝细胞癌并胆管癌栓的CT及MRI诊断

目的探讨肝细胞癌（hepatocellular carcinoma,HCC）并胆管癌栓的CT及MRI表现特点。方法回顾性分析2007年—2014年收治的48例经手术证实为HCC并胆管癌栓患者的CT及MRI表现特点。结果 45例术前CT或/和MRI增强扫描发现胆管癌栓,位于肝左叶16例、右叶20例、尾状叶6例、累及左右肝6例,CT表现为胆管内稍低或等密度软组织影,增强扫描大部分呈＂早进早退＂的肝细胞癌强化特征,部分不典型表现者呈中等度强化或轻度强化;MRI表现为肝内或/和肝外胆管内结节状或团块状稍长T1稍长T2信号影,DWI上信号不均匀增高,同反相位及STIR上信号未见明显衰减,增强扫描为与原发灶＂快进快出＂相似的强化特点。梗阻远端胆管膨胀性扩张;胆管壁无增厚或受侵表现且Satoh等2简化临床分型后,Ⅰ型左叶、右叶、尾状叶、左右肝叶分别为6例、7例、2例、2例,Ⅱ型分别为8例、10例、3例、3例,Ⅲ型分别为1例、2例、0例、1例。结论肝细胞肝癌并胆管癌栓CT及MRI表现有一定的特征,可帮助术前明确诊断。

CT and MRI Diagnosis of Hepatocellular Carcinoma with Bile Duct Tumor Thrombus

Objective To study the CT and MRI features of hepatocellular carcinoma（HCC） with bile duct tumor thrombus. Methods A retrospective analysis was conducted on the CT and MRI features of 48 patients with HCC and bile duct tumor thrombus proved by surgery. Results Before operation, 45 cases were found with bile duct tumor thrombus by CT or/and MRI enhanced scan, the bile duct tumor thrombus of 16 cases was in the left lobe of liver, that of 20 cases was in the right lobe of liver, that of 6cases was in the Spigelian lobe, and that of 6 cases involved left and right hepatic bile duct, CT showed slightly low or isopycnotic shadow of soft tissue in the bile duct, enhanced scan mostly showed ＂hepatocellular carcinoma early into the early＂ enhanced features, part of atypical manifestations were moderate enhancement or slight enhancement; MRI manifestations showed intrahepatic or/and extrahepatic bile duct nodular or mass like slight long T1 and T2 signal intensity, DWI signal increased heterogeneously,reverse phase and STIR signal had no obvious attenuation, enhancement scanning had enhanced features similar to those of primary ＂Kuaijinkuaichu＂. The bile duct at the far-end of obstruction expansilely dilatated; bile duct wall no thickening or invasion and Satoh expression of 2 simplified clinical type, in left lobe, right lobe, caudate lobe, left and right hepatic lobe, type Ⅰ were 6 cases, 7 cases, 2 cases, 2 cases, respectively, type II were 8 cases, 10 cases, 3 cases, 3 cases, type III was 1 case, 2 cases, 0 case and 1 case. Conclusion The CT and MRI manifestations of hepatocellular carcinoma with bile duct tumor thrombus have certain features, which can help the preoperative diagnosis.