肝门部胆管癌超声造影与增强MRI增强模式的对比研究

目的 探讨肝门部胆管癌超声造影(CEUS)及增强MRI(CEMRI)增强模式的影像学特征.方法 对21例手术病理证实为肝门部胆管癌患者的术前超声造影及增强MRI图像中病灶的增强水平及增强形态进行比较.结果 (1)21例肝门部胆管癌病灶超声造影动脉期多显示为高增强(14/21,66.7%),门脉期(19/21,90.5%)及延迟期多消退为低增强(21/21,100%);显示病灶增强均匀8个(8/21),不均匀13个(13/21).(2)21例肝门部胆管癌病灶增强MRI动脉期多显示为高增强(14/21,66.7%),门脉期以等增强为主(11/21,52.4%),延迟期多显示为等增强(6/21,28.6 %)或高增强(12/21,57.1%);显示病灶增强均匀6个(6/21),不均匀15个(15/21).(3)肝门部胆管癌超声造影动脉期显示不同增强水平的病灶数与增强MRI比较差异无统计学意义(χ2=1.167,P>0.05);超声造影门脉期及延迟期与增强MRI增强水平显示的病灶数比较差异有统计学意义(χ2=24.867、31.500,P<0.05).肝门部胆管癌病灶超声造影与增强MRI显示增强均匀性的病灶数比较差异无统计学意义(χ2=0.429,P>0.05).结论 肝门部胆管癌在超声造影及增强MRI动脉期表现无明显差异,而门脉期及延迟期的表现则不同,超声造影可作为增强MRI诊断肝门部胆管癌的有益补充,从而增加诊断医师对肝门部胆管癌的诊断信心.

Comparison between contrast-enhanced ultrasound and contrast-enhanced magnetic resonance imaging on the enhancement pattern of hilar cholangiocarcinoma

Objective To investigate the enhancement pattern of hilar cholangiocarcinoma on contrast-enhanced ultrasound（CEUS） and contrast-enhanced magnetic resonance imaging（CEMRI）.Methods Twenty-one patients with hilar cholangiocarcinoma confirmed by pathology were examined by CEUS and CEMRI.The enhancement patterns of the lesions were compared between the two imaging modalities.Results（1） On CEUS,most of hilar cholangiocarcinoma lesions were hyper-enhanced（14/21,66.7%） in arterial phase,and hypo-enhanced in portal（19/21,90.5%） and late phase（21/21,100%）.In addition,eight lesions（8/21） showed diffuse homogeneous enhancement,while thirteen lesions（13/21） showed diffuse heterogeneous enhancement on CEUS.（2） On CEMRI,most of hilar cholangiocarcinoma lesions were hyper-enhanced（14/21,66.7%） in arterial phase,iso-enhanced（11/21,52.4%） in portal phase and iso-enhanced（6/21,28.6%） or hyper-enhanced（12/21,57.1%） in late phase.In addition,six lesions（6/21） showed diffuse homogeneous enhancement and fifteen lesions（15/21） showed diffuse heterogeneous enhancement on CEMRI.（3） The difference of lesion enhancment in arterial phase between CEUS and CEMRI was not significant（χ2=1.167,P〈0.05）.But there was a significant difference between CEUS and CEMRI on lesion enhancement in portal and late phase（χ^2=24.867,31.500,P〈0.05）.There was no significant difference between CEUS and CEMRI on the number of the lesions showing diffuse homogeneous or heterogeneous enhancement（χ^2=0.429,P〈0.05）.Conclusions The enhancement pattern of hilar cholangiocarcinoma on CEUS is not different with that on CEMRI in arterial phase,whereas they are significantly different in the portal and late phase.CEUS can be used as a useful supplement to CEMRI and increase the confidence of the doctors when diagnosing the hilar cholangiocarcinoma.