不同形态类型肝内胆管细胞癌的CT诊断

CT diagnosis of intrahepatic cholangiocarcinoma with different morphologic types

目的:探讨不同形态类型肝内胆管细胞癌的CT表现。方法:回顾性分析经病理证实的20例肝内胆管细胞癌的形态特点和动态增强CT表现。结果:20例肝内胆管细胞癌中肿块型14例,管周浸润型4例,管内生长型2例。肿块型平扫表现为不规则低密度肿块,动态扫描早期肿瘤周边呈环状强化,中心部分早期呈轻度强化或不强化,延迟期呈现持续性强化为特征性表现;管周浸润型表现为沿胆管树走行的分枝状软组织肿块,边缘不清,远侧胆管扩张,动态扫描肿瘤呈渐进性延迟强化;管内生长型表现为扩张胆管内的乳头状或结节状病变,动态扫描早期呈轻度均匀性强化,延迟期无强化。结论:不同形态类型肝内胆管细胞癌的CT表现不同,术前影像学检查明确ICC的形态学类型,有助于临床选择合理的治疗方案并判断患者预后。

Objective：To study CT features of intrahepatic cholangiocarcinoma（ICC） with different morphologic types. Methods：The morphologic characteristics and dynamic enhancement CT manifestations of 20 patients with ICC proved pathologically were reviewed retrospectively. Results.. Twenty ICCs were classified into three types based on the morphologic characteristics of tumors： mass-forming type（ n = 14）, periductal-infiltrating type （ n = 4）, and intraduetal growth type （ n = 2）. Mass-forming types showed hypoattenuating mass-like lesions with irregular margins. On dynamic imagings, the tumors showed typically thin, incomplete,rimlike enhancement both the arterial and portal venous phases, and the central part of the tumors showed mild enhancement or no enhancement at the early phase, whereas there were prolonged enhancement at the delayed phase; periductal-infiltrating types extended along the biliary tree and showed ill-defined branchlike masses with dilatation of the peripheral bile ducts, the involved bile ducts showed diffusely narrowing or obliteration. On dynamic imagings, the tumors showed gradually prolonged enhancement; intraductal growth types showed nodular or papillary lesions within the dilated bile duct. On dynamic imagings, the tumors showed mild homogenous enhancement at the early phase and no enhancement at the delayed phase. Conclusion： The different morphologic types of ICC have different CT features. Morphologic types of ICC should be determined with preoperative imaging studies,and it is useful for planning and choosing the appropriate treatment and for predicting prognosis.