胆管细胞性肝癌与肝细胞性肝癌侵犯胆管的CT及MRI影像学特征分析

CT and MR Imaging Differences Between Intrahepatic Cholangiocarcinoma and Hepatocellular Carcinoma with Invasions to Biliary Tracts

目的探讨胆管细胞性肝癌(ICC)与肝细胞性肝癌(HCC)侵犯胆管的CT及磁共振显像(MRI)特征的差别,提高对二者鉴别诊断的准确性。方法对经手术病理证实侵犯胆管的18例ICC和32例HCC病例进行CT或MRI影像学特征对比研究。结果ICC侵犯胆管影像学特征表现为:胆管扩张程度明显、扩张胆管粗细不均、管壁增厚伴明显强化,扩张胆管常位于肿块中;其肿块表现为边缘轻度强化或无强化。HCC侵犯胆管表现为:胆管扩张程度轻、扩张胆管受推压,管壁增厚或强化少见,扩张胆管常位于肿块旁;其肿块主要表现为造影剂"快进快出"的强化方式。两者在以上方面差异均有统计学意义(P<0.05)。结论ICC和HCC侵犯胆管的影像学表现有显著差异,CT或MRI有助于二者的鉴别诊断。

Objective To identify the CT and MR imaging differences between intrahepatic cholangiocarcinoma （ICC） and hepatocellular carcinoma （HCC） with invasions to biliary tracts. Methods Eighteen patients with ICC and 32 HCC patients with invasions to biliary tracts confirmed by postoperative pathological diagnosis were enrolled in the study. All of the patients underwent CT or MR examinations. The image features about the tumor and the biliary tracts were analyzed retrospectively. Results The imaging features of ICC were： faint rim-like enhancement and no enhancement of the masses. The ICC invasions to biliary tracts were shown as severe dilation of biliary tracts, coarse-to-fine or separation of dilated tracts, thickened and enhanced walls, dilation of biliary tract encased in the mass. The HCCs showed quick fill-in and wash-out of the contrast media in the mass. The imaging features of HCC with invasions to biliary tracts were., mild dilated tracts, compressed and extruded tracts, thickening of the wall of dilated tracts and enhancement of the walls. The location of the dilated tracts were mostly alongside of the tumors. The cbi square tests revealed significant differences between ICC and HCC in the above features （P〈0.05）. Conclusion CT or MR imaging may help differentiate ICC and HCC with invasions to biliary tracts.