肝门胆管癌的MSCT与MRI诊断

The value of multislice spiral computed tomograhy and magnetic resonance in diagnosis of hepatic hilar cholangiocarcinoma

目的:探讨MSCT、MRI及MRCP对肝门胆管癌的诊疗价值。方法:收集18例肝门胆管癌患者,全部病例行MSCT检查,其中8例同时行MRI及MRPC检查。结果:18例中浸润型9例,结节型6例,乳突型3例。直接征象表现为胆管壁不规则增厚及狭窄、肝门区结节或肿块、乳头状或息肉状向腔突出的小结节。18例中,平扫发现可疑直接征象9例,增强扫描18例全部显示清晰,病灶从轻到中度强化,均有延迟期持续强化。8例MSCT、MRI及MRCP对比:MRI平扫发现1例,CT平扫未能发现的肝门结节;MRCP发现2例,CT及MRI平扫未能显示的管壁浸润,4例肝门结节MRCP均未能显示。间接征象主要有:①18例均有肝门病灶区以上肝内胆管扩张,呈弥漫性柱状、"软藤状"、"蟹足状"或囊状;4例累及一侧胆管为局部胆管扩张;扩张胆管由肝门向外周延伸,胆总管无扩张;②3例受累侧肝叶萎缩;③4例肝叶局部受侵及肝门血管被包饶;④5例肝门淋巴结转移。结论:MSCT、MRI及MPCP对诊断肝门胆管癌有重要价值,三种方法结合运用,能明显提高诊断率,对临床确定治疗方案可提供准确有效的依据。

Objective：To investigate the value of multilayer spiral comppted＇ tomograhy （MSCT）, magnetic resonance imaging （MRI） and magnetic resonance cholangiopancreatography （MRCP） in diagnosis and treatment of hepatic hilar eholangiocarcinoma （HHCC）. Methods：18 eases of patients with HHCC were performed with MSCT, and 8 csaes of them were also performed with MRI and MRCP. Results：Among the 18 cases with HHCC, infiltrating type occurred in 9 cases, nodal-like type in 6 and papillary-like type in 3. Direct signs showed bile duct thickened and stenosis irregularly, nodus or tumor in hepatic hilar region, and papillar or polypoid tubercle growed into bile duct. Among the 18 cases, direct signs were found doubtfully in 9 cases before injecting contrast agent. While enhancement scanning showed all focus which manifested from mild to moderate and continual in lag period clearly. Compared the images of Mscr with MRI and MRCP before enhancement scanning in 8 cases, MRI showed one more case of hilar nodus than CT. MRCP showed infiltration of bile duct wall in 4 cases while MRI and CT only showed 2 cases of them. However hilar nedus were not showed by MRCP in 3 cases. There were some important indirect signs： ① Bile duct above the lesion presented cholangiectasis liking pillar, soft vine, crab-feet or capsular in all of 18 cases. Mono-side bile duct involved in 4 cases. Dilated bile duct extended from hepatic portal to periphery and no dilation showed in common bile duct; ②Involved fiver lobes presented atrophy in 3 cases; ③ Liver lobes were infiltrated locally and hilar blood vessel were encased in 4 cases; ④ Metastasis of hilar lymph node showed in 5 cases. Conclusion： MSCT, MRI and MRCP is very important in diagnosis of HHC. And combined these three methods will not only inprove file diagnostic rate of HHC, but also offer effective and precise evidence for the clinic treatment.