CT与MR成像在肝门胆管癌术前分型及可切除性评估价值

Role of CT and MRI on preoperative evaluation of hepatic hilum cholangiocarcinoma

目的研究肝门区胆管癌的CT与MRI影像表现,评估肝门区胆管癌的周围浸润,探讨综合影像学方法在肝门区胆管癌的术前分型及可切除性评估价值。方法回顾性分析经手术病理证实的23例肝门区胆管癌CT与MRI增强扫描、CTA、MRCP表现,影像学分型与手术所见的临床分型对照,CT/MRI术前可切除性评估与手术结果比较。结果 23例肝门区胆管癌均显示肝门区肿块,增强以延迟强化为主,肝内胆管不同程度扩张;CT与MRI增强扫描联合CTA、MRCP可有效显示胆管受侵范围、血管受侵情况、肝实质及淋巴结有无转移。影像学分型与手术分型无显著性差异(P>0.05)。CT/MRI综合评价肿瘤是否可切除的敏感性、特异性及准确性分别为81.8%、91.6%及86.9%。结论 CT联合MRI,能客观有效地显示肝门区胆管癌的浸润范围,有助于临床进行术前分型及可切除性评估。

Objective To explore the value of CT and MRI on preoperative evaluation of hepatic hilum cholangiocarcinoma.Methods CT/MRI and CTA,MRCP findings in 23 patients of hepatic hilum cholangiocarcinoma proved pathologically were retrospectively analyzed.Imaging classification and clinical classification were compared,as well preoperative evaluations and operative results were compared.Results All patients were found to have soft tissue mass at porta hepatis with delayed enhancement,and intrahepatic biliary duct dilation was seen.CT/MRI and CTA,MRCP imaging could find infiltrated bile duct and blood vessel objectively,metastatic tumor also could be seen availably.The classification was of no significant difference between CT/MRI and operation findings（P0.05）.The sensitivity and specificity and accuracy of preoperative evaluation in all patients of hepatic hilum cholangiocarcinoma were 81.8% and 91.6% and 86.9% in our study.Conclusions CT combined with MRI was valid method in the anatomical analysis of hilar cholangiocarcinoma,and they were helpful in clinical classification and preoperative evaluation.