肝胆管细胞癌并发肝脓肿的MSCT诊断

目的:探讨肝胆管细胞癌并发肝脓肿患者的MSCT诊断价值。方法:收集15例肝胆管细胞癌合并肝脓肿患者的MSCT资料进行回顾性分析。结果:15例患者CT平扫图像上发现31处边界模糊的低密度病灶,包括15处肝内胆管细胞癌和16处肝脓肿。病灶位于肝右叶者12处,位于肝左叶者19处,其中10例患者肝胆管细胞癌和肝脓肿位于同一肝段或肝叶,5例患者肝胆管细胞癌和肝脓肿位于不同肝段或肝叶。15处肝胆管细胞癌中,肿块型5处,表现为肝实质内轻～中度环形强化结节,常不伴有周围胆管扩张;管周浸润型4例,表现为沿胆管纵轴生长的树枝状肿块,伴有周围胆管扩张;肿块并管周浸润型6例,表现为肝实质内轻～中度延迟强化结节,常伴周围胆管扩张。16处肝脓肿病灶动态强化CT图像上,表现为中央完全强化者3处;中央不完全强化者6处,其中表现为伴中央小范围不强化者2处,表现为花簇状、多间隔强化者4处;表现为中央不强化者7例,称为肝脓肿的典型表现,即周围环形强化而中央不强化。结论:肝内胆管细胞癌和肝脓肿有着不同的强化特征,因此动态增强CT对同时患有肝胆管细胞癌和肝脓肿的患者有重要价值。

Multi-slice CT diagnosis of intrahepatic cholangiocarcinoma complicated with hepatic abscess

Objective：To analyse the CT features of the cases with intrahepatic cholangiocarcinoma complicated with he- patic abscess and to evaluate its value in the diagnosis of these cases. Methods The CT features of 15 pathologically con- firmed cases with intrahepatic cholangiocarcinoma and hepatic abscess together were retrospectively reviewed and analysed. Results：On the plain CT scans, 31 lesions were found with ill defined low density. Among 31 lesions, there were 15 intra- hepatic cholangiocarcinomas and 16 hepatic abscesses. Lesion invoivement of 31 lesions included left lobe of liver （n= 19） and right lobe （n= 12）. There were 10 cases that both of intrahepatic cholangiocarcinoma and hepatic abscess involved the same hepatic lobe or segment and 5 cases that both of them involved different lobes or segments. On the enhanced CT ima- ging, 15 intrahepatic cholangiocarcinomas were classified into four types： mass-forming type （n = 5）, a nodular mass in the liver parenchyma without dilatation of the peripheral ducts; periduetal-infiltrating type （n = 4）, extended longitudi- nally along the bile duct and formed a branchlike mass with dilatation of the peripheral ducts; mass-forming plus periduc- tal-infiltrating type （n= 6）, a nodular mass in the liver parenchyma with dilatation of the peripheral ducts; intraductal growth type （n= 0）. On the enhanced CT imaging, 16 hepatic abscesses were divided into three types： complete central enhancement （i. e. , entirely solid, n = 3） ; incomplete central enhancement subdivided into type A, which showed a small central area with poor enhancement （n = 2）, and type B, which showed peripheral enhancement and a multiseptal core en- hancement, suggesting a multiloculated abscess （n = 4） ; and no central enhancement, the so called classic appearance of a hepatic abscess, with central low attenuation and peripheral ring enhancement （n = 7）. Conclusion; There are different features between intrahepatic cholangiocarcinoma and hepatic abscess on the enhanced CT scanning. Thus, CT dynamic scanning has an important value in the diagnosis of the cases with intrahepatic cholangiocarcinoma and hepatic abscess to- gether.