肝内胆管癌的螺旋CT表现及病理基础(附20例分析)

目的:探讨肝内胆管癌螺旋CT增强扫描表现与病理学的关系,以及螺旋CT的诊断价值。方法:经手术病理证实的20例肝内胆管癌行常规上腹部平扫和增强扫描,增强扫描在注入对比剂后20s和60s分别行动脉期和门静脉期扫描,另有14例加做4～15min的延迟期扫描,分析肝内胆管癌影像特征和病理基础。结果:病灶肿块型16例,浸润狭窄型2例,胆管内生长型2例。增强早期边缘无强化者6例,边缘强化者14例,延迟增强后内部不均匀强化者8例,均匀强化者2例,无强化者4例。病理学上周边强化是由于肿瘤边缘存在活癌组织,而延迟强化是由于肿瘤中心部分存在丰富的纤维组织。此外螺旋CT还清楚显示了肝内胆管扩张,肝叶萎缩,病灶周围异常强化区等间接现象。结论:肝内胆管癌的CT表现与病理密切相关,早期病灶边缘轻度强化,延迟期中心部强化是诊断肝内胆管癌的重要影像依据。

Spiral CT Diagnosis of Intrahepatic Cholangiocarcinoma and Correlation with Pathological Findings (Report of 20 Cases)

Ojectives:To evaluate diagnostic value of contrast-enhanced helical CT in intrahepatic cholangi ocarcinoma and correlating the CT features with pathologic findings.Methods:Pre-and post-contrast CT scanning of upper abdomen were performed in 20 cases with intrahepatic cholangiocarcinoma.arterial phase 20s and the portal venous phase 60s.14 of 20 cases underwent additional delayed scans began at 4~15min.CT and pathological findings were analyzed.Results:According to the pathological types,mass-type was found in 16 case,infiltrative-type in 2 cases,and intracavitary-type in 2 cases.No contrast enhancement (6 cases) or mild or moderate rim-like enhancement (14 cases) were the most frequent enhancement patterns observed in early stage.on the delay scan imaging,the center of the tumors showed mottling,reticular,or homogeneous enhancement.moreover,ancillary findings including the intrahepatic biliary ducts,hepatic lobar atrophy,The abnomal enhancement areas peripheral to the tumor were also seen in helical CT.Conclusion:The typical CT appearances of intrahepatic cholangiolarcinoma include:hypodensity of hepatic lesion on precontrast scan,peripheral enhancement in the early stage,and central delay enhancement.