肝内胆管细胞癌CT、MR表现与病理特征对照分析

CT and MRI Manifestations of Intrahepatic Cholangiocarcinomas and Correlation with Pathological Changes

目的旨在加深对肝内胆管细胞癌CT、MRI表现的认识,提高诊断的准确性。方法经组织病理学证实、行CT、MRI检查肝内胆管细胞癌33例,共51个病灶。观察其CT、MRI表现包括形态和边缘,密度、信号和强化特点,灶周和肝外改变,同时将病理改变与CT、MRI表现相对照。结果 51个病灶中CT和MRI显示形态不规则肿块为35/51,占68.6%,16个病变呈结节状,占31.4%。45个病灶有坏死囊变区,占88.2%,22病灶内胆管扩张,占43.1%,22个病灶内见结石,占43.1%。动态增强,于动脉期呈病灶周边带状强化,类似炎症病变充血状改变29例,占56.9%。肿瘤本身动脉期边缘环形强化,内部结节状强化,门静脉期与延时期病变持续强化,占100%。腹膜呈带状或线状增厚、肝门脂肪间隙模糊(共9例,占27.2%),腹腔内淋巴结肿大(19例,占57.6%)。病理改变主要为癌细胞团及其间见大量结缔组织,由纤维组织、丰富的血管及炎性细胞组成,周围见宽广的炎性细胞浸润。结论肝内胆管细胞癌CT、MRI表现具有特征性,并与其病理基础相关。认识以上特征与病理改变,能提高诊断的准确性。

Objective To increase the recognition on CT and MRI features of intrahapatic cholangiocarcinomas and improve the accuracy of diagnosis. Methods The CT and MRI were examined in 33 patients with intrahapatic cholangiocarcinoma total 51 focus and all the cases were proved by histopathology. The margins, characters of densities or signals, types of enhancement, livers around focus and the changes outside livers of intrahapatic cholangiocarcinomas in CT and MRI were observed that were collated with the pathological changes. Results The main manifestaions of CT and MRI in intrahapatic cholangiocarcinomas were that irregular margins of masses account for 35151 （68.6%）, the nodal mass account for 16/51 （31.4%）, necroses or cystoid changes were seen in 45 focus （88.2%）, cholangio-dilatations were seen in 22 focus （43.1% ）, calculis in bile duct were seen in 22 focus （43.1% ）. In dynamic enhancement, enhancement of masses showed hades and irrgular shapes in arterial phases and continued to enhancement in portal phases account for 100%. The livers around masses were zonally enhanced in arterial phases in 29 focus （56.9%） that resemble inflammatory congestion. The peritoneal incrassation and blurry structures of porta hepatis were seen in 9 patients （27.2%）. Lymphoid nodes swelled in celiae in 19 patients （57.6%）. The pathological changes were carcinoma celles and abundant connective tissue that consist of fibroblasts, blood vessels and inflammatory cells. The soakages of inflammatory cells showed around liver tissues. Conclusions The CT and MRI manifestations of intrahapatic cholangiocarcinomas have some characters that were relative with the pathological changes. It has important significance for corretly diagnosis to understand the CT and MRI characters and the pathological bases.