肝内胆管细胞癌的螺旋CT动态扫描及临床表现特点分析

The Clinical Characteristics and CT Features of Intrahepatic Cholangiocarcinoma

目的探讨肝内胆管细胞癌的螺旋CT动态扫描和临床表现特征。资料与方法回顾性分析经手术病理证实的肝内胆管细胞癌32例,所有病例均行CT平扫和动态增强扫描,全部病例均行乙型肝炎全套检查,25例行甲胎蛋白(AFP)检查,8例行肿瘤标志物CA19-9、CA125及CA242检查。结果 9例动脉期病灶周边呈花边样、环状强化,静脉期及延时期进一步强化,中心大片低密度坏死;14例动脉期周边轻度强化,静脉期及延时期向心性强化,伴病灶内及周围胆管扩张;4例表现为轻度不均匀强化;1例表现为肿块主要向肝外生长,1例表现为肝内多发肿块及结节,明显强化;3例表现为肝内胆管轻度扩张,未见明显肿块。10例合并胆管结石,25例AFP检查为阴性,8例肿瘤CA19-9、CA125及CA242均有明显升高。结论肝内胆管细胞癌的多层螺旋CT动态扫描表现具有一定特征性,结合肿瘤标志物的检测,有助于提高对其诊断的正确率。

Objective To analyze the CT features and clinical characteristics of intrahepatic cholangiocarcinoma.Materials and Methods Thirty-two cases of intrahepatic cholangiocarcinoma proved by surgery and pathology were analyzed retrospectively.Both unenhanced and dynamic enhanced CT scanning were performed in all patients.Assays of either viral antigens or antibodies of hepatitis B were detected in all cases,AFP in 25 cases and tumor marker’s protein,such as CA199,CA125 and CA242 in 8 cases were examed.Results Thin,rimlike contrast enhancement around the tumor at the arterial phase and concentric filling of contrast material at the equilibrium phase were found in 9 cases,and the central part of the tumor was low-attenuation necrosis without enhancement during these phases.Minimal peripheral enhancement during arterial phase,more enhanced central portion during portal venous phase,and focal dilatation of intrahepatic ducts around the tumor were found in 14 patients.Minimal heterogeneous enhancement were found in 4 cases.Multiple tumors or nodes and remarkable enhancement were found in 1 case.slight dilatation of intrahepatic ducts were found in 3 cases and no mass were found.In 32 cases,calculus of intrahepatic bile ducts was found in 10 cases.AFP was negative in 25 cases,and titer about CA199,CA125 and CA242 apparently rised in 8 cases.Conclusion The imaging features of dynamic enhanced CT scanning in intrahepatic cholangiocarcinoma has certain characteristic.Combined with tumor markers protein,the accuracy of dynamic enhanced CT scanning in diagnosis of intrahepatic cholangiocarcinoma could be improved.