肝内胆管细胞癌的CT特点及病理基础

Relationship between CT imaging features of intrahepatic cholangiocarcinoma and pathological characteristics

目的对比研究肝内胆管细胞癌(IHCC)的CT表现与病理的关系。方法分析病理学证实的肝内胆管细胞癌患者22例,比较CT平扫及动态增强扫描方式和病理学特点。结果 IHCC在CT平扫期均为圆形或类圆形或不规则低密度肿块,动态增强扫描动脉期均呈不规则轻度强化,以边缘强化为主,门脉期病灶可无明显强化,或轻度片状、分隔状或延迟性强化。IHCC组织病理学上见肿瘤外周以存活的肿瘤细胞为主,形成早期边缘强化,而肿瘤中央以纤维成分为主,形成延迟强化的基础。结论动态增强动脉期边缘轻度强化,延迟后强化范围增加或不变是IHCC的典型表现,增生的纤维组织是延迟强化的病理基础。增强期分叶状或花瓣状肿瘤形态及肝内胆管扩张是IHCC的特异性表现,有一定的病理学基础。

Objective To study relationship between the histopathologic findings and imaging features on the CT of intrahepatic eholangiocarcinoma （IHCC）. Methods Twenty-two patients with pathologically proven IHCC were reviewed by CT scanning and pathology. Results On unenhanced CT, the lesions showed round or oval tumor of low density with ill - defined border. Dynamic CT of typical IHCC showed the presence of thin, mild or incomplete rim-hke contrast enhancement at the tumor periphery as well as delayed reinforcement. Macroscopically and microscopically, cholangiocarcinomas showed much carcinoma cell and a little fibrous tissue at the periphery but a lot of fibrous tissue in the center of the tumor. Conclusion Thin contrast enhancement at the tumor periphery in arterial phase as well as delayed reinforcement is the typical performance because of the hyperplastic fibrous tissue. Lobulated or flower-hke tumor in enhanced phase and intrahepatic biliary dilatation is IHCC specific performance in CT.