18例肝内胆管细胞癌的CT表现分析

CT findings of intrahepatic peripheral cholangiocarcinoma

目的为了进一步提高对肝内周围型胆管细胞癌(IPCC)CT诊断的准确性。方法搜集2000年10月至2005年3月间在我院诊治的IPCC 18例,并经手术病理证实,对其螺旋CT平扫+增强的表现进行回顾性分析。结果研究证实,本组患者CT直接征象是平扫肝实质内见低或略低密度边缘模糊不清的类圆形、不规则形及分叶形的占位性病灶,增强早期肿瘤周边轻度强化之后为逐渐增强的向心性强化;间接征象是肝内胆管扩张,肝叶萎缩,周边肝被膜回缩,病灶周围血管改变及肝门、后腹膜淋巴结肿大等。结论肝内胆管细胞癌临床上多无肝硬化表现,AFP多阴性,肿块较大,且伴有钙化,增强早期肿瘤周边轻度强化之后为逐渐增强的向心性强化,高度提示IPCC。

Objective To elevate further the diagnostic accuracy of intrahepatie peripheral cholangiocarcinoma （IPCC）.Methods Eighteen patients with surgically and pathologically proved IPCC were collected from October 2000 to March 2005 in our hospital.CT findings of IPCC without and with contrast enhancement in all patients were retrospectively analyzed.Results The study demonstrated that the direct signs on unenhanced images were round,irregular and lobulated space-occupying lesions with hypodense or slight hypodense and ill-defined border in liver parenchyma,slight enhancement of tumoral border on early enhanced images,and gradual enhamcement from the periphery toward the center of the lesion on delayed phase; the indirect signs included dilatation of intrahepatic bile ducts around the lesions,atrophy of hepatic lobes,retraction of liver capsules,vascular changes around the lesions,and lymphanode enlargment of hepatic porta and posterior peritoneum.Conclusion The patients with IPCC mostly lack the manifestation of hepsto-cirrhosis,while AFP is negative,however,larger mass associated with calcification and gradual enhancement from the periphery toward the center of the lesion during dynamic enhanced scans are highly suggestive of IPCC.