肝门部浸润型胆管癌的MSCT与高场MRI诊断

MSCT and High-field MRI in the Diagnosis of Infiltrating Cholangiocarcinoma at Porta Hepatis

目的:分析MSCT与高场MRI在肝门部管壁浸润型胆管癌(IHCC)诊断中的价值。方法:回顾性分析15例IHCC的MSCT与高场MRI表现,所有病例均经病理及临床综合诊断证实,15中8例行CT、MRI及磁共振胰胆管成像(MRCP)检查,4例仅行CT扫描,余3例仅行MRI及MRCP检查。CT及MRI检查均包括平扫及多期动态增强扫描。结果:15例CT或MRI平扫均见肝内胆管扩张,5例显示扩张的肝管逐渐狭窄变细,10例显示扩张肝管呈突然截断征象,7例显示扩张的左右肝管未能汇合。强化扫描显示肝门部胆管壁不规则增厚,管腔狭窄,所有病例均见结节样小灶性肿物。15例中12例病变于动脉期即见明显均匀强化,门静脉期及平衡期亦呈高密度或高信号;3例于动脉期呈边缘环状明显强化,延迟扫描强化渐趋均匀。结论:IHCC的影像学表现有一定特征,MSCT及高场MRI对其诊断具有重要意义。

Objective：To study the value of multislice computed tomography（MSCT）and high-field MRI in the diagnosis of infiltrating hilar choloangiocarcinoma（IHCC）.Methods：MSCT and MRI findings in 15 patients with pathology and comprehensive clinical studies proved IHCC were retrospectively analyzed.Eight of the 15 cases underwent CT,MRI and MRCP,4 cases underwent CT scan only,the remaining 3 cases underwent MRI and MRCP.All cases had plain and dynamic-enhanced CT and/or MRI.Results：On plain CT or MRI,all of the 15 cases showed intra-hepatic biliary tract dilatation,5 cases showed gradually narrowing and tapering of dilated biliary duct,10 cases showed abrupt cut-off of dilated biliary duct,and in 7 cases convergence of dilated left and right hepatic ducts was not showed.On enhanced images,all cases showed irregular thickening of the wall of biliary duct,narrowing of the lumen as well as small nodular mass.In 12 of the 15 cases,lesions enhanced obviously on hepatic artery phase,and maintain high density or high signal intensity on portal venous phase as well as hepatic parenchymal phase,3 of them showed ring shape enhancement on hepatic artery phase,and enhanced homogeneously on delayed phase.Conclusion：To some extent,CT and MRI of IHCC showed characteristic imaging findings;MSCT and high-field MRI play an essential role in the diagnosis of IHCC.