肿块型肝内胆管细胞癌的MSCT诊断

CT Features of Mass-forming Intrahepatic Cholangiocarcinoma

目的分析肿块型肝内胆管细胞癌(intrahepatic cholangiocarcinoma,ICC)的多层螺旋CT(MSCT)表现。资料与方法回顾性分析56例经病理证实的ICC患者的MSCT表现,对肝脏形态、胆道结石、胆管扩张、病灶的强化方式、门静脉形态及肝十二指肠及腹膜后淋巴结等进行分析总结。结果 56例中54例行平扫加增强扫描,其中环形强化21例(38.9%),片状强化24例(44.4%),延迟强化39例(72.2%),无明显强化1例(1.9%);门静脉变窄或闭塞37例(68.5%),门静脉癌栓15例(27.8%);周围胆管扩张35例(62.5%);子灶18例(32.1%);胆道结石21例(37.5%),ICC合并同叶肝内胆管结石17例(30.4%);肝叶萎缩20例(35.7%);包膜皱缩38例(67.9%);肝十二指肠韧带和/或腹膜后淋巴结肿大31例(55.4%);胆囊炎36例(64.3%)。ICC合并同叶肝内胆管结石的发生率与ICC不合并同叶肝内胆管结石的发生率二者间的差异具有统计学意义(χ2=9.905,P=0.002)。结论环形或片状强化、延迟强化、门静脉狭窄/闭塞、包膜皱缩是肿块型ICC的主要CT特征性表现。

Objective To analyze the MSCT features of mass-forming intrahepatic cholangiocarcinoma（ICC）. Materials and Methods CT features of 56 patients with pathologically confirmed ICC were retrospectively investigated. The hepatic morphology, biliary calculi, dilatation of bile ducts, enhancement mode, portal vein morphology, enlargement of lymph nodes of hepatic-duodenal ligament and/or retroperitoneum were studied. Results Plain and enhanced CT images were obtained in 54 of 56 patients. Rim enhancement, pathy enhancement, and delayed enhancement were seen in 21 （38.9%）, 24 （44.4%）, and 39 （72.2%）cases, respectively. One case showed no enhancement. Narrowing or obliteration of portal veins were seen in 37 patients. Intra-portal vein thrombosis were seen in 15 patients. Dilated peripheral bile ducts were seen in 35 patients. The satellite nodules were seen in 18 cases. Biliary calculi were seen in 21 cases, among theses cases, 17 patients had a mass within the same lobe. Segmental atrophy was seen in 20 patients. Capsular retraction of hepatic parenchyma was seen in 38 patients. Enlargement of lymph nodes of hepatic-duodenal ligament and/or retroperitoneum were seen in 31 patients. Cholecystitis was seen in 36 patients. The incidence of ICC was greater in lobes having biliary calculi than in lobes without biliary calculi（ X^2 = 9. 905, P = 0. 002）. Conclusion A hypo attenuation mass with rim or pathy enhancement, delayed enhancement, narrowing or obliteration of the portal vein, capsular retraction of the liver parenchyma are the main MSCT characteristic findings of ICC.