肝胆管囊腺瘤及囊腺癌的CT诊断

目的 探讨肝内胆管囊腺瘤及囊腺癌的CT表现及其病理学改变，评价CT对其诊断价值。方法 搜集6例经手术病理证实的肝胆管囊腺瘤及囊腺癌的病例，其中3例作常规CT平扫及增强扫描，3例作螺旋CT平扫及肝动脉门静脉双期增强扫描。回顾性分析6例肝内胆管囊腺瘤及胆管囊腺癌的CT表现，并与病理组织检查结果对照。结果 1例胆管囊腺瘤，呈多囊性病灶，囊壁光整，厚薄一致，部分分隔有较均匀的增厚。1例胆管囊腺瘤恶变，为单囊性病灶；4例胆管囊腺癌中3例为单囊性病灶，1例为多囊性病变。CT均见囊内主要为水样密度，5例恶性者中4例可见壁结节和(或)乳头状突起，另外1例有囊壁局部增厚；3例有厚薄不均的分隔，2例有囊壁钙化，1例有囊内出血，呈液液平征。常规增强扫描囊壁和分隔有强化。螺旋CT双期增强扫描动脉期囊壁及壁上结节明显强化，门脉期强化减退。结论 CT可显示肝内胆管囊腺瘤和囊腺癌的一些特征性表现，却难于鉴别良性胆管细胞囊腺瘤与恶性胆管细胞囊腺癌。如见病灶有间隔增厚、壁上结节或乳头状突起、囊内出血以及伴粗大钙化者多考虑为恶性的胆管细胞囊腺癌，肝内胆管囊腺瘤与囊腺癌鉴别主要依靠病理。

The CT findings of hepatic biliary cystadenoma and cystadenocarcinoma

Objective To evaluate the CT features and the pathologic basis of intrahepatic biliary cystadenoma and cystadenocarcinoma. Methods Six cases of biliary cystadenoma and cystadenocarcinoma were collected. All cases were conformed by operation and pathology. Plain scan and enhanced scan were performed in three cases. Plain scan and double phase (arterial and portal) enhanced scan with spiral CT were performed in other three cases. The CT features of 6 cases of biliary cystadenoma and cystadenocarcinoma were analyzed retrospectively and correlated with the pathologic findings. Results one case was biliary cystadenoma with multilocular cyst and one was canceration from the biliary cystadenoma. The other four cases were cystadenocarcinoma, three with single cyst and the other one with multilocular cyst. All of six cases were revealed as cystic mass in CT scan. Of the 5 malignant tumors, four cases had mural nodules and/or papillary excrescences and the other one had cystic wall thickening. Irregular thickening of internal septa was shown in three cases. Two had calcification and one had bleeding in the cyst and fluid-fluid level. Conclusion CT scan can reveal the some characteristic features of biliary cystadenoma and cystadenocarcinoma. But differentiation between biliary cystadenoma and cystadenocarcinoma is still difficult on CT scan. Manifestations with irregular thickening of internal septa, mural nodules, papillary excrescences, bleeding in the cyst and coarse calcifications increase the likelihood of the diagnosis of biliary cystadenocarcinoma.