混合型肝癌的多期增强影像表现及与其他类型原发性肝癌的比较

目的 探讨混合型肝癌（cHCC-CC）的CT、MRI多期增强影像表现，并与其他类型原发性肝癌对比分析。方法 回顾性分析25例经病理证实的cHCC-CC的多期增强影像表现，并依据临床及影像表现分别与200例普通类型肝细胞癌（HCC）、51例硬化型肝癌（SHCC）、104例肝内肿块型胆管癌（IMCC）进行比较，分析其差异。结果 cHCC-CC的多期增强强化方式主要分为3种：动脉期肿瘤呈整体不均匀强化，平衡期仍见持续不均匀强化（n=12）；动脉期肿瘤呈不均匀强化，平衡期对比剂流出，呈低密度/低信号改变（n=8）；动脉期肿瘤呈边缘环状强化，平衡期对比剂呈环状或不规则状向内填充（n=5）。cHCC-CC在年龄、性别、病毒性肝炎病史、血管受侵及淋巴结转移与HCC、SHCC、IMCC差异无统计学意义（P均>0.05），而与IMCC比较，cHCC-CC更常见于肝硬化患者（P<0.001）。cHCC-CC邻近肝包膜皱缩的发生率明显低于SHCC和IMCC（P=0.021、0.005），AFP与CA19-9升高的比例与IMCC差异有统计学意义（P=0.005、0.001）。结论 cHCC-CC是原发性肝癌的少见类型，其影像及临床表现与HCC、SHCC及IMCC既重合，又有其特征性，准确诊断有助于临床治疗方案的选择和对预后的判断。

Multiphasic contrast-enhanced imaging features of combined hepatocellular carcinoma and cholangiocarcinoma: Comparative with other primary hepatic carcinoma

Objective To investigate multiphasic contrast-enhanced CT and MRI findings of combined hepatocellular carcinoma and cholangiocarcinoma (cHCC-CC), and to make a comparison between cHCC-CC and other primary hepatic carcinoma.Methods The CT and MRI features of twenty-five patients with cHCC-CC confirmed by pathology were retrospectively reviewed. The clinical and imaging features of cHCC-CC were compared with 200 cases of common type hepatocellular carcinoma (HCC), 51 cases of scirrhous hepatocellular carcinomas (SHCC) and 104 cases of intrahepatic mass-forming cholangiocarcinoma (IMCC).Results The multiphasic contrast-enhanced imaging patterns of cHCC-CC were divided into three types:Type 1, persistent heterogeneous enhancement from arterial phase to equilibrium phase (n=12); type 2, heterogeneous enhancement in the arterial phase and wash-out during equilibrium phase with low density or hypointensity (n=8); type 3, peripheral rim enhancement in the arterial phase, followed by rim or irregular centripetal enhancement during equilibrium phase (n=5). There was no statistical difference between cHCC-CC and HCC, SHCC and IMCC in age, gender, hepatitis, incidence of vein invasion and lymph node metastasis (allP>0.05). Compared to IMCC, cHCC-CC was frequently observed in patients with hepatic sclerosis (P<0.001). However, incidence of liver with surface retraction in cHCC-CC was lower than that of SHCC and IMCC (P=0.021, 0.005). The levels of serum AFP and CA19-9 showed difference between cHCC-CC and IMCC (P=0.005, 0.001).Conclusion cHCC-CC is an unusual type of primary HCC. It has not only mostly same features with common type HCC, SHCC and IMCC, but also characteristic with them. Accurately diagnosis is helpful for selection of clinical therapeutic scheme and prognosis.