肝内周围型胆管细胞癌的MRI诊断

MRI diagnosis of intrahepatic peripheral cholangiocellular carcinoma

目的探讨MRI对肝内周围型胆管细胞癌(IHPCC)的诊断及鉴别诊断价值。方法回顾性分析经手术病理证实的IHPCC 28例,分别作MRI平扫和动态增强扫描。结果在MRI图像上,IHPCC主要表现为分叶状或不规则形、混杂密度或信号、无包膜的软组织肿块;动态增强扫描肿瘤呈"慢进慢出"表现,动脉期肿瘤以边缘轻～中度强化为主,延迟扫描出现从周边到中心的向心性、延迟强化;其他征象包括瘤内见扩张的胆管8例,病灶周围或远端胆管扩张20例,包膜回缩征象12例,局部肝萎缩8例,肝门后或腹膜后淋巴结转移10例,均无门静脉癌栓形成。结论 IHPCC的MRI表现具有一定的特征性,可为IHPCC的诊断及鉴别诊断提供重要的依据;MRI新技术的应用更能反映肿瘤的病理特征。

Objective To evaluate the value of MRI in the diagnosis and differential diagnosis of intrahepatic peripheral cholangiocellular carcinoma （ IHPCC ）. Methods Retrospective report was made in 28 patients with IHPCC that was pathologically proved by surgical operation. They received MRI plain and dynamic enhancement scanning. Results On the MRI imaging, IHPCC mainly appeared as nonencapsulated mass with lobulated or irregular shape and mixed intensity or signal. The dynamic enhancement scanning showed that the tumor was the type of ＂slowly - in and slowly out＂. The rim of tumor in arterial phase was mainly reinforced in light - middle degree. The delayed scanning showed centrality and delayed reinforcement from rim to centre. Other signs included bile duct dilation within tumors （ 8 cases ）, cholangiectasis around or distant from the focus （ 20 cases ）, envelope retraction （ 12 cases ）, regional hepatatrophia（ 8 cases）and lymph node metastasis behind porta hepatis or retroperitoneal lymph node metastasis （10 cases）. Tumor thrombosis in portal veins was not observed. Conclusion The MPI manifestation of IHPCC has certain characteristics, which can provide important evidence for the diagnosis and differential diagnosis of IHPCC. The application of this new technique can show preferably the pathological characteristics of this tumor.