三维动态增强磁共振血管成像对肝细胞癌和肝内胆管癌门脉受侵的诊断价值

The value of 3D DCE MRA in the diagnosis of portal vein involvement by hepatocellular carcinoma and intrahepatic cholangiocarcinoma

目的 探讨三维动态增强MRA(3DDCEMRA)对肝细胞癌和肝内胆管癌门脉受侵的诊断价值。方法 搜集手术及病理证实的肝细胞癌(HCC) 2 1例,肝内胆管癌(IHCC) 14例,后者包括肝门型胆管细胞癌10例,周围型胆管细胞癌(IHPCC) 4例。MR检查包括平扫、3DDCEMRA。结果 HCC组4 2支门脉主分支中,6支门脉侧壁虫噬样侵犯,8支门脉癌栓;IHCC组2 8支门脉主分支中,3支局部管壁受侵,5支缩窄,7支闭塞;两组病例的门脉受侵形式差异有非常显著性意义(P <0 0 5 )。结论 3DDCEMRA诊断肝细胞癌和肝内胆管癌门脉受侵具有较高的准确性、无创伤性和直观性,且在鉴别诊断上具有重要意义,能为临床手术及治疗方案的选择提供很大的帮助。

Objective To evaluate 3DDCEMRA in the diagnosis of portal vein involvement by hepatocellular carcinoma and intrahepatic cholangiocarcinoma. Methods Twenty-one cases of HCC and 14 cases of IHCC(10 cases of hilar IHCC and 4 cases of IH PCC included) confirmed by surgery and pathology were enrolled in this study. Plain and 3DDCEMRA were performed. Results 6 cases of portal vein infiltration(6/42) and 8 cases of tumor thrombosis(8/42) were demonstrated in HCC group, and IHCC group had 3 cases of portal vein infiltration(3/28), 5 cases of narrowing(5/28) and 7 cases of occlusion(7/28). Significant difference was found in portal vein invasion between HCC group and IHCC group(P<0.05). Conclusion 3DDCEMRA is accurate, non-invasive and simple in the diagnosis of portal vein involvement by hepatocellular carcinoma and intrahepatic cholangiocarcinoma, and is useful for differentiat diagnosis. It is very helpful for the selection of opoeration and treatment regimen.